Differential plasma metabolites are associated with PeALT risk
We evaluated the correlations between the levels of differential metabolites and clinical parameters. As shown in Figure 3A and 3B, Ser-Phe-Ala and NALM had the strongest negative and positive correlation with ALT and AST levels, respectively, implying that these two metabolites may be associated with liver injury in patients with CHB. Moreover, 3-Mx was negatively associated with white blood cells and neutrophils. Multivariate logistic regression analysis further confirmed that these metabolites were associated with PeALT risk, even after adjusting for age, sex, BMI, low density lipoprotein, platelet, total cholesterol, and TG (Table 2). These findings suggest that the correlation between serum metabolites and the risk of elevated ALT levels may be independent of BMI and metabolic syndrome. The ROC curve revealed that Ser-Phe-Ala (AUC = 0.843, 95% CI 0.75–0.93) and Lys-Ala-Leu-Glu (AUC = 0.839, 95% CI 0.744–0.934) can be used to distinguish patients with PeALT from those with PnALT (Figure 3C). The findings indicate that plasma metabolites are associated with PeALT risk and may be potential biomarkers for diagnosing PeALT.