{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T14:24:35Z","timestamp":1784298275830,"version":"3.55.0"},"reference-count":44,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic hepatitis D (CHD) causes severe chronic hepatitis. Knowledge is limited about factors correlating with ALT in treatment\u2010na\u00efve patients with CHD. This study analysed the pattern and determinants of ALT elevation in a large cohort of patients with CHD, including young adults, compared to propensity score\u2010matched (PSM) patients with chronic hepatitis B (CHB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified 2382 treatment\u2010na\u00efve HBsAg+ adults with CHD (HDV RNA positive) and 1553 with CHB attending a liver center in Mongolia during 2015\u20132023. The correlation between ALT levels, virological, biochemical, and fibrosis parameters was assessed using Spearman coefficient (rho). Logistic regression analysis was used to identify determinants of elevated ALT in 1371 PSM pairs with CHD and CHB matched on age, sex, metabolic factors, and date of initial test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In CHD, 78.5% of patients had ALT elevation, with the highest prevalence in the 18\u201320\u2009years group (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009219, 84.5%). This age group displayed 8.2\u2010adjusted odds ratio (aOR) for elevated ALT, 2.7\u2010aOR for elevated GGT, and 4.5\u2010aOR of cirrhosis than matched CHB group (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05). In CHD, ALT correlated weakly with HDV RNA (rho\u2009=\u20090.23) and liver stiffness (rho\u2009=\u20090.37), moderately with GGT (rho\u2009=\u20090.48), while showed no correlation with HBV DNA or HBsAg. Independent factors for elevated ALT were age\u2009&lt;\u200930\u2009years, elevated GGT and HDV RNA levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large cohort of Asian patients, an earlier and more severe inflammatory process could be demonstrated in CHD compared to CHB regardless of liver cirrhosis. Longitudinal studies are warranted to risk\u2010stratify and prioritise patients for therapies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.70559","type":"journal-article","created":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T10:42:21Z","timestamp":1772966541000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence and Risk Factors of Elevated Alanine Aminotransferase (ALT) in 2382 Treatment\u2010na\u00efve HBV\/HDV Co\u2010Infected Patients"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6662-7813","authenticated-orcid":false,"given":"Habiba","family":"Kamal","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Karolinska University Hospital  Stockholm Sweden"},{"name":"Department of Medicine Huddinge Karolinska Institutet  Stockholm 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Sweden"},{"name":"Unit of Hepatology, Department of Upper GI Diseases Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Bruce","sequence":"additional","affiliation":[{"name":"Cytel Statistical Consultancy  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Ingre","sequence":"additional","affiliation":[{"name":"Unit of Hepatology, Department of Upper GI Diseases Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bekhbold","family":"Dashtserenx","sequence":"additional","affiliation":[{"name":"The Liver Center  Ulaanbaatar Mongolia"},{"name":"ONOM Foundation  Ulaanbaatar Mongolia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oyungerel","family":"Lkhagva\u2010Ochir","sequence":"additional","affiliation":[{"name":"The Liver Center  Ulaanbaatar Mongolia"},{"name":"ONOM Foundation  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