Abstract
ObjectiveTo develop a simple predictive model for significant fibrosis and cirrhosis in chronic hepatitis B (CHB) using the routine hematological parameters of a complete blood count.MethodsA total of 458 eligible CHB patients who had undergone a liver biopsy were randomly divided into two cohorts: an estimation group (n = 310) and a validation group (n = 148). Liver histology was assessed according to the Metavir scoring scheme. All common demographics, hematological parameters, HBeAg status, HBV DNA, and liver biochemistry were analyzed.ResultsBased on routinely available clinical parameters (age, sex, HBeAg status, HBV DNA, common hematological parameters of a complete blood cell count), a model for predicting significant fibrosis (Metavir score ≥2) in the estimation group was derived using platelets and red cell distribution width (RDW), and another model for predicting cirrhosis (Metavir score = 4) was derived using platelets, RDW and hemoglobin. A novel index, the RDW to platelet ratio (RPR), was developed to amplify the opposing effects of liver fibrosis on the RDW and platelets. The AUCs of the RPR for predicting significant fibrosis and cirrhosis were 0.825 and 0.884, respectively, which is superior to the AAR, FIB-4 and APRI in the estimation group. Compared with the two derived models, the RPR has a comparable predictive power for significant fibrosis and cirrhosis. Using optimized cutoffs (0.10 and 0.16), the RPR accurately predicted 63.1% of cases with significant fibrosis and 73.7% of cases with cirrhosis and accurately excluded 85.5% of the cases with mild fibrosis and 93.0% of the cases with no cirrhosis.ConclusionThe RPR, a routinely available, inexpensive and easily calculated index, can predict significant fibrosis and cirrhosis in CHB patients with relatively high accuracy. The application of this index may reduce the need for liver biopsy in CHB patients.
Highlights
Liver fibrosis and cirrhosis are major causes of morbidity and mortality in chronic hepatitis B (CHB) patients
Knowledge of the stages of liver fibrosis is essential in patients with viral hepatitis B to assess the progression and prognosis of the disease, when determining whether to use antiviral treatment [1,2]
Study Population A total of 603 patients with CHB who had undergone a percutaneous liver biopsy were enrolled in the study
Summary
Liver fibrosis and cirrhosis are major causes of morbidity and mortality in chronic hepatitis B (CHB) patients. Antiviral therapy has greatly reduced the risk of fibrosis and cirrhosis, some patients may eventually develop advanced fibrosis and cirrhosis. Knowledge of the stages of liver fibrosis is essential in patients with viral hepatitis B to assess the progression and prognosis of the disease, when determining whether to use antiviral treatment [1,2]. Liver biopsy remains the gold standard for assessing the histological outcomes of liver disease [3]. This procedure is costly and carries a small risk of complications due to sampling error and invasiveness [4]. Non-invasive, economical and simple methods to assess the severity of hepatic fibrosis are considered to be attractive
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