---
title: >-
  Longitudinal ALT Trajectories are Generally Stable Among Patients with
  Non-Alcoholic Fatty Liver Disease (NAFLD): An Investigation Using Artificial
  Recurrent Neural Networks.
description: >-
  Explore this publication on real-world evidence: Longitudinal ALT Trajectories
  are Generally Stable Among Patients with Non-Alcoholic Fatty Liver Disease…
date: '2022-01-01'
category: Publications
tags:
  - EASL Congress
  - Poster Presentation
  - R&D
  - Care
  - Hepatology
  - MASH/MASLD
  - Pharma Partner
  - Health System Partner
canonical_url: >-
  https://www.pedestalhealth.com/resources/publications/easl-congress/longitudinal-alt-trajectories-are-generally-stable-among/
source: Pedestal Health
license: © 2026 Pedestal Health. All rights reserved.
slug: longitudinal-alt-trajectories-are-generally-stable-among
id: 4YdlEjdYrvXZg1KJ9xh0zK
contentType: article
---

## Challenge

ALT is widely used as a liver injury biomarker in NAFLD trials, but the natural longitudinal variability of ALT in real-world patients—and the patient characteristics that predict ALT trajectory—had not been modeled at scale, limiting confidence in ALT-based endpoint interpretation.

## Solution

The TARGET-NASH cohort was analyzed using a recurrent neural network to model longitudinal ALT transitions across four categories, with a multivariable logistic model identifying predictors of ALT category increase, providing the first machine learning-based real-world ALT trajectory characterization in NAFLD.

## Impact

Demonstrating that ALT trajectories are generally stable and characterizing predictors of change provides drug developers and regulators with empirical noise estimates for ALT-based endpoints, directly informing endpoint variability assumptions and responder threshold design in NAFLD trials.

### [Breda Munoz](/people/breda-munoz/)

![Breda Munoz, PhD — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/3H1T2mfvSNFj6w9tulnreq/a74ae05fe53e400f176d4e9c617b8fb8/breda-munoz.jpg)

### [Andrea R. Mospan](/people/andrea-mospan/)

![Andrea R. Mospan, PhD, RAC — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/4w6bkwPHPqrXKYs4tHZPkK/1d21763b54ecc3466764986693b7072f/andrea-mospan.jpg)

### [Heather L. Morris](/people/heather-morris/)

![Heather Morris, PhD — Profile Photo](https://images.ctfassets.net/h4s3ip99qawo/16PnQ817q7tv964vhcUD5f/ce6797c32df11f022ef12ecbb9ffea49/heather-morris.jpg)