{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T05:41:05Z","timestamp":1790401265179,"version":"4.1.0"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,1,4]],"date-time":"2024-01-04T00:00:00Z","timestamp":1704326400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background and Aims<\/jats:title><jats:p>We aimed to define gender\u2010specific, optimal alanine aminotransferase (ALT) cut\u2010off values for the prediction of significant liver histological changes (SLHC) in Chinese patients with grey zone (GZ) chronic hepatitis B (CHB) and normal ALT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a retrospective study, we included 1101 consecutive patients with GZ CHB and normal ALT assigned to training or internal validation cohorts. We included an independent cohort of 842 patients for external validation. We performed receiver operating characteristic (ROC) curve, smoothed curve fitting, and threshold effect analyses to determine optimal ALT cut\u2010off values. Area under the curve (AUC) values were calculated to assess their predictive performance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A proportion of 79.3% of patients with GZ CHB and normal ALT (\u226440\u2009U\/L) had SLHC. ROC curve analysis initially identified optimal ALT cut\u2010off values of 29\u2009U\/L (male) and 22\u2009U\/L (female). After smoothed curve fitting and threshold effect analyses, new optimal cut\u2010off values were 27\u2009U\/L for males and 24\u2009U\/L for females. AUCs for these values were 0.836 (male) and 0.833 (female) in the internal validation cohort, and 0.849 (male) and 0.844 (female) in the external validation cohort. The accuracy and discriminative ability of the newly defined ALT cut\u2010off values were greater than those of the current recommendations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This study established novel optimal ALT cut\u2010off values for more precise prediction of SLHC among Chinese patients with GZ CHB and normal ALT levels. This may help identify individuals who will benefit from timely antiviral therapy.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apt.17862","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T07:19:45Z","timestamp":1704439185000},"page":"692-704","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Determining optimal <scp>ALT<\/scp> cut\u2010off values for predicting significant hepatic histological changes in patients with normal <scp>ALT<\/scp> in the grey zone of chronic hepatitis B virus infection"],"prefix":"10.1111","volume":"59","author":[{"given":"Na\u2010Ling","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province, Fujian Medical University  Fuzhou China"},{"name":"Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u2010Ying","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province, Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital Clinical Research Center for Hepatopathy and Intestinal Diseases of Fujian Province, Fujian Medical University  Fuzhou China"},{"name":"Department of Hepatology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital Fujian Medical University  Fuzhou 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