ALT is an interesting example of the choice of "what is a true healthy reference interval" versus "what feels right from our population's results". The "pragmatic" or the in-house derived ranges I've seen seem to be about double the NICE guidance concentrations you quote (note NICE are consistent with some published a priori intervals with aggressive exclusion criteria). I wonder if it's a coincidence that a lot of decision cutoffs for ALT are stated as twice the reference interval.
I guess it depends what message we should send to our users... Is a lower cutoff falsely reassuring in the presence of mild or chronic disease, or does it reduce GP concern for the vast majority of patients who are just overindulging a bit and may(?) not require intervention? What's more important?
On Tue, 13 Oct 2015 12:27:37 +0000, Jordaan Marieke <[log in to unmask]> wrote:
>Dear colleagues
>
>It would be interesting to get an impression of the ALT reference range used in other laboratories.
>
>NICE CG165 on Diagnosis and Management of Chronic Hepatitis B, published in June 2013 (http://www.nice.org.uk/guidance/cg165/evidence/cg165-hepatitis-b-chronic-full-guideline3) makes reference to ALT a number of times, and bases important clinical decisions on "normal", "abnormal" and "normalized" ALT levels, which they define as greater than or equal to 30 IU/L for males and greater than or equal to 19 IU/L for females
>
>There is some explanation of why these cutoffs were chosen on page 159:
>[cid:image003.jpg@01D105BB.0FBF3EF0]
>
>With alcohol use and obesity now so common the impact of using these ALT reference ranges on diagnostic investigations could be very significant.
>
>Harmony does not appear to have agreed a cutoff for ALT, unlike other LFT.
>
>If you want to reply with your cutoff only, I will collate the responses for the mailbase.
>
>
>
>Regards
>
>Marieke
>
>Dr Marieke Jordaan
>
>Consultant Chemical Pathologist
>Mid-Yorkshire Trust
>
>Email: [log in to unmask]
>Tel: (01924) 317060 or ext 57060
>PA, Diane Blakeston: (01924) 317056 or ext 57056
>
>
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