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Brent A. Neuschwander-Tetri, MD; Aynur Ünalp, MD, PhD; Michael H. Creer, MD; for the Nonalcoholic Steatohepatitis Clinical Research Network

Arch Intern Med. 2008;168(6):663-666.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

Chronic liver disease can progress to cirrhosis if not detected early and appropriate interventions taken when possible. Serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase are commonly measured during routine health care examinations to detect such unsuspected liver disease. Care providers often use the reporting laboratory's ALT upper reference limit (upper limit of normal [ULN]) or a multiple thereof (eg, 1.5 x ULN) to trigger further evaluation. Such evaluation can be expensive and invasive, yet ignoring aminotransferase elevations can allow life-threatening liver disease to progress if not recognized and treated appropriately. Therefore, how clinical laboratories define their own ALT ULN values is critically important in determining the risk-benefit ratio of further evaluation.

For technical reasons related to sample stability, validated standards are not used to establish a ULN for ALT . . . [Full Text of this Article]

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