Diagnostic value of γ-glutamyl transpeptidase-to-platelet ratio index for hepatic fibrosis in patients with chronic hepatitis B

Abstract

Objective To compare the diagnostic values of γ-glutamyl transpeptidase-to-platelet ratio index (GPRI), aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for chronic hepatitis B(CHB) fibrosis and cirrhosis. Methods According to the Metavir score, 262 CHB patients were divided into F0—F1 group (n=131), F2—F3 group (n=102) and F4 group (n=29). The age, gender, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidas (γ-GT) and platelet count were recorded. GPRI, APRI, Fib-4 scores were calculated separately. Statistical analysis was performed by t test, Kruskal-Wallis H test, and χ2 test. The correlations between serum models and liver fibrosis stages were analyzed using the Spearman test. Results The scores of GPRI in F0—F1 group, F2—F3 group and F4 group were 0.39 (0.21, 0.95), 1.05 (0.38, 2.39) and 2.11 (1.12, 3.33), respectively. The difference was statistically significant (χ2=40.645, P<0.01). APRI scores in the three groups were 0.49 (0.32, 0.97), 0.77 (0.52, 1.52) and 1.12 (0.77, 2.50), respectively. The difference was statistically significant (χ2=32.636, P<0.01). Fib-4 scores in the three groups were 1.36 (0.92, 2.05), 2.34 (1.28, 4.35) and 3.86 (3.03, 8.99), respectively. The difference was statistically significant (χ2=48.943, P<0.01). Age, γ-GT, AST and liver fibrosis were all positively correlated with liver fibrosis (r=0.322, 0.301 and 0.199, respectively, all P<0.05). Platelet was negatively correlated with liver fibrosis (r=—0.455, P<0.05), while ALT was not significantly associated with hepatic fibrosis (r=0.111, P=0.073). GPRI, APRI and Fib-4 were positively correlated with liver fibrosis (r=0.625, 0.417 and 0.399, respectively, all P<0.05). The areas under the operating characteristic curve of GPRI for significant hepatic fibrosis, advanced liver fibrosis and cirrhosis were 0.818, 0.864 and 0.837, respectively. APRI for significant hepatic fibrosis, advanced liver fibrosis and cirrhosis were 0.694, 0.766 and 0.722, respectively, while Fib-4 were 0.696, 0.770 and 0.724, respectively. The low cutoff values of GPRI for various stages of liver fibrosis were 0.99, 1.04 and 1.06, respectively, and the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were all higher than those of APRI and Fib-4. The high cutoff values of GPRI for liver fibrosis at each stage were 2.49, 3.69 and 6.77, respectively, and the sensitivity, specificity, PPV and NPV of the diagnosis were all higher than those of APRI and Fib-4. Conclusion The diagnostic value of GPRI for CHB liver fibrosis is higher than those of APRI and Fib-4. Key words: Hepatitis B, chronic; Liver fibrosis; γ-glutamyl transpeptidase; Platelets; Prognosis