Abstract
ObjectivesNoninvasive models have been established for the assessment of liver fibrosis in patients with chronic hepatitis B(CHB). However, the predictive performance of these established models remains inconclusive. We aimed to develop a novel predictive model for liver fibrosis in CHB based on routinely clinical parameters.ResultsPlatelets(PLT), the standard deviation of red blood cell distribution width(RDW-SD), alkaline phosphatase(ALP) and globulin were independent predictors of significant fibrosis by multivariable analysis. Based on these parameters, a new predictive model namely APRG(ALP/PLT/RDW-SD/globulin) was proposed. The areas under the receiver-operating characteristic curves(AUROCs) of APRG index in predicting significant fibrosis(≥F2), advanced fibrosis(≥F3) and liver cirrhosis(≥F4) were 0.757(95%CI 0.699 to 0.816), 0.763(95%CI 0.711 to 0.816) and 0.781(95%CI 0.728 to 0.835), respectively. The AUROCs of the APRG were significantly higher than that of aspartate transaminase(AST) to PLT ratio index(APRI), RDW to PLT ratio(RPR) and AST to alanine aminotransferase ratio(AAR) to predict significant fibrosis, advanced fibrosis and cirrhosis. The AUROCs of the APRG were also significantly higher than fibrosis-4 score (FIB-4) (0.723, 95%CI 0.663 to 0.783) for cirrhosis(P=0.034) and better than gamma-glutamyl transpeptidase(GGT) to PLT ratio(GPR) (0.657, 95%CI 0.590 to 0.724) for significant fibrosis(P=0.001).Materials and Methods308 CHB patients who underwent liver biopsy were enrolled. The diagnostic values of the APRG for liver fibrosis with other noninvasive models were compared.ConclusionsThe APRG has a better diagnostic value than conventionally predictive models to assess liver fibrosis in CHB patients. The application of APRG may reduce the need for liver biopsy in CHB patients in clinical practice.
Highlights
Hepatitis B virus (HBV) infection is a serious public health problem globally
The area under the receiver operating characteristic curve (AUROC) of the APRG were significantly higher than fibrosis-4 score (FIB-4) (0.723, 95%confidential interval (CI) 0.663 to 0.783) for cirrhosis(P=0.034) and better than gamma-glutamyl transpeptidase(GGT) to PLT ratio(GPR) (0.657, 95%CI 0.590 to 0.724) for significant fibrosis(P=0.001)
AUROC: area under the receiver operating characteristic curve; CI: confidence interval; LR-: negative likelihood ratio; LR+: positive likelihood ratio; aminotransferase (ALT) ratio (AAR): aspartate aminotransferase to alanine aminotransferase ratio; APRI: aspartate aminotransferase to platelet ratio index; FIB-4: fibrosis index based on the four factors; GPR: gamma-glutamyl transpeptidase to platelet ratio; RPR: red cell distribution width to platelet ratio
Summary
Liver fibrosis and cirrhosis are major reasons of morbidity and mortality in patients with chronic hepatitis B (CHB) [1]. Assessing the stages of liver fibrosis in CHB patients could help clinicians predict the disease progression and formulate the optimally therapeutic schedule to avoid sever complications [2]. Liver biopsy (LB) is recognized as the gold standard for estimating histological stages of liver diseases [3, 4]. Sampling errors and observer discrepancy associated with liver biopsy may bias the result of liver fibrosis. It does not allow the dynamic observation of liver fibrosis by LB. Non-invasive, inexpensive and convenient methods for assessing liver fibrosis are urgently needed
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