Prognostic Value of Inflammatory Indicators in Chronic Hepatitis B Patients With Significant Liver Fibrosis: A Multicenter Study in China.

Xiujuan Zhang,Shanshan Lin,Shuduo Wu,Xiaoling Chi,Yusheng Jie,Xiaoju Wu,Huanming Xiao,Jiao Gong,Ming Lin,Zemin Wan,Yingxian Li,Minling Cao,Meijie Shi

doi:10.3389/fphar.2021.653751

Abstract

Diagnosis of significant liver fibrosis is essential to facilitate the optimal treatment decisions and improve prognosis in patients with chronic hepatitis B (CHB). We aimed to evaluate the value of inflammatory indicators and construct a nomogram that effectively predicts significant liver fibrosis among CHB patients. 563 CHB patients from two centers in China from 2014 to 2019 were divided into three cohorts (development, internal validation, and independent validation cohorts), assigned into cases with significant fibrosis (liver fibrosis stages ≥2) and those without. Multiple biochemical and serological inflammatory indicators were investigated. Inflammatory indicators, Alanine aminotransferase (ALT) and aspartate aminotransferase (AST), were significantly associated with significant liver fibrosis in CHB patients but limited predictive performance, and then we combined them with prothrombin time activity percentage (PTA) and liver stiffness measurement (LSM) were identified by multivariate logistic regression analysis. Based on these factors, we constructed the nomogram with excellent performance. The area under the receiver operating characteristic curve (AUROC) for the nomogram in the development, internal validation, and independent validation cohorts were 0.860, 0.877, and 0.811, respectively. Our nomogram based on ALT and AST that had excellent performance in predicting significant fibrosis of CHB patients were constructed.

Highlights

According to World Health Organization (WHO) statistics, hepatitis B virus (HBV) infection is a common global public health problem (296 million people were living with HBV infection and with 1.5 million new infections every year), in Eastern Asia (WHO, 2020)
Compared with the four independent risk factors alone and two other traditional predictors (FIB-4 and APRI), the AAPL nomogram had excellent performance in the three cohorts; the area under the receiver operating characteristic curve (AUROC) of the nomogram for predicting significant liver fibrosis in chronic hepatitis B (CHB) patients was better than the AUROC of ALT (AUROC 0.618, 95% CI 0.553–0.684), AST (AUROC 0.687, 95% CI 0.627–0.747), PTA (AUROC 0.701, 95% CI 0.239–0.359), liver stiffness measurement (LSM) (AUROC 0.821, 95% CI 0.773–0.87), FIB-4 (AUROC 0.697, 95% CI 0.638–0.757), and APRI (AUROC 0.725, 95% CI 0.669–0.781), as well as high sensitivity and specificity (Figure 2A and Table 3)
Accurate assessment of the liver fibrosis stage is essential to determine whether CHB patients need to receive anti-viral treatment, as recommended by the American Association for the Study of Liver Diseases (AASLD) (Terrault et al, 2018)

Summary

Introduction

According to World Health Organization (WHO) statistics, hepatitis B virus (HBV) infection is a common global public health problem (296 million people were living with HBV infection and with 1.5 million new infections every year), in Eastern Asia (WHO, 2020). Persistent infection with HBV can progress to cirrhosis and hepatocellular carcinoma (HCC), which is one of the most frequent cancers in our country (ElSerag, 2012), have high morbidity and mortality (Marcellin, 2009). To reduce the disease adverse consequences of HBV infection, it. Liver fibrosis is characterized by an overall increase in the extracellular matrix, mainly produced by hepatic stellate cells (HSCs) (Xiao et al, 2020). It involves a phenotypic switch induced by numerous cell types in a cytokine-mediated inflammatory process. Treatment for liver fibrosis can significantly reduce the inflammatory process and decrease the high mortality rate by successfully preventing cirrhosis and HCC.

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Conclusion