Abstract
Background and Aim Little information is available about the assessment and optimal use of the gamma-glutamyl transpeptidase-to-platelet ratio (GPR) and transient elastography (TE) in predicting liver cirrhosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD). This study is aimed at comparing their diagnostic performances and developing an optimal approach for predicting liver cirrhosis in CHB patients with NAFLD. Methods Consecutive CHB patients with NAFLD were enrolled. The GPR was calculated, and TE was performed using liver biopsy as a reference standard. The accuracy of predicting liver cirrhosis using GPR and TE was assessed and compared, and an optimal approach was developed. Results Both TE and GPR correlated significantly with the histological fibrosis stage. TE and GPR had excellent performance in predicting liver cirrhosis, and the comparison of areas under the receiver operating characteristic curves revealed that TE was superior to GPR (0.95 vs. 0.85, P = 0.039). Moreover, the dual cutoffs established by the likelihood ratio showed that GPR had a similar misclassification but higher indeterminate rate than TE (54.5% vs. 11.7%, P < 0.001). Additionally, a 2-step approach using GPR followed by TE had comparable performance to that of both GPR and TE tests for all patients (misclassification: 8.9% vs. 8.3%, P = 0.866; indeterminate rate: 15.2% vs. 17.2%, P = 0.750) but could reduce TE scans by approximately one-third. Conclusions Both TE and GPR show excellent performance in predicting liver cirrhosis in CHB patients with NAFLD. The 2-step approach using GPR followed by TE may be optimal for the assessment of cirrhosis in CHB patients with NAFLD.
Highlights
Hepatitis B virus (HBV) infection continues to be a significant health threat, and an estimated 257 million people are chronically infected [1, 2]
transient elastography (TE) and glutamyl transpeptidaseto-platelet ratio (GPR) had excellent performance in predicting liver cirrhosis, and the comparison of areas under the receiver operating characteristic curves revealed that TE was superior to GPR (0.95 vs. 0.85, P = 0:039)
Forty-eight patients were further excluded for the following reasons: 1 patient had concurrent hepatocellular carcinoma (HCC), 32 patients had ALT or AST levels ≥ 5 times of upper limit of normal (ULN), and 15 patients had Body mass index (BMI) ≥ 30 kg/m2; 145 patients met the study criteria and were included in the final analysis (Figure 1)
Summary
Hepatitis B virus (HBV) infection continues to be a significant health threat, and an estimated 257 million people are chronically infected [1, 2]. Little information is available about the assessment and optimal use of the gamma-glutamyl transpeptidaseto-platelet ratio (GPR) and transient elastography (TE) in predicting liver cirrhosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD). This study is aimed at comparing their diagnostic performances and developing an optimal approach for predicting liver cirrhosis in CHB patients with NAFLD. The accuracy of predicting liver cirrhosis using GPR and TE was assessed and compared, and an optimal approach was developed. Both TE and GPR show excellent performance in predicting liver cirrhosis in CHB patients with NAFLD.
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