Development of algorithms based on serum markers and transient elastography for detecting significant fibrosis and cirrhosis in chronic hepatitis B patients: Significant reduction in liver biopsy

2016 ◽  
Vol 46 (13) ◽  
pp. 1367-1379 ◽  
Author(s):  
Yan Li ◽  
Qun Cai ◽  
Yafei Zhang ◽  
Qinxiu Xie ◽  
Nan Xu ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Chronic Hepatitis B ◽  
Transient Elastography ◽  
Serum Markers ◽  
Significant Fibrosis

scholarly journals A Simple Noninvasive Model to Predict Significant Fibrosis in Children With Chronic Hepatitis B

2020 ◽  
Author(s):  
Kang-Ling Zhang ◽  
Xiu-Qi Chen ◽  
Zi-Li Lv ◽  
Li Huang ◽  
Xiang Yun ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Receiver Operating Characteristic ◽  
Chronic Hepatitis B ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Operating Characteristics ◽  
Significant Fibrosis ◽  
Receiver Operating

Abstract Objectives: to develope a noninvasive model for significant fibrosis in children with chronic hepatitis B (CHB).Methods: A total 116 CHB pediatric patients who had undergone liver biopsy were included in the study. Blood routine examination, coagulation function, liver biochemistry, viral serology and viral load were analyzed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values.Results: Based on the correlation and difference analysis, 7 available clinical parameters [Total bile acid (TBA), Gamma-glutamyl transpeptidase(GGT), Aspartate transaminase(AST), Direct bilirubin to total bilirubin ratio (D/T), Alanine aminotransferase(ALT), Prealbumin (PA),and Cholinesterase（CHE）] were included for modeling analysis. A model to predict significant liver fibrosis (Ishak fibrosis score ≥2) was derived using the two best parameters (PA and GGT) The original model was . After mathematical calculation, the G index 600×GGT/PA2 predicts significant fibrosis with an area under the receiving operating characteristics (AUROC) curve of 0.733，95% IC (0.643-0.811). The area under the receiver operating characteristic curve (AUROC) of G index (0.733,) was higher than that of APRI (0.680) and FIB-4(0.601) to predict significant fibrosis in children with CHB. If the G index's values outside 0.28-1.16, 52% of children with CHB could avoid liver biopsy with an overall accuracy of 75%.Conclusions: The G index can predict and exclude significant fibrosis in children with HBV, which may reduce the liver biopsy need for children with CHB.

scholarly journals Transient Elastography for Significant Liver Fibrosis and Cirrhosis in Chronic Hepatitis B: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-13 ◽  
Author(s):  
Xiaolong Qi ◽  
Min An ◽  
Tongwei Wu ◽  
Deke Jiang ◽  
Mengyun Peng ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Hepatitis B ◽  
Diagnostic Accuracy ◽  
Chronic Hepatitis B ◽  
Transient Elastography ◽  
Meta Analysis ◽  
Receiver Operating Curve ◽  
Significant Fibrosis ◽  
Receiver Operating

Background. The hepatitis B virus infection is a global health issue and the stage of liver fibrosis affects the prognosis in patients with chronic hepatitis B (CHB). We performed the meta-analysis describing diagnostic accuracy of transient elastography (TE) for predicting CHB-related fibrosis. Methods. We performed an adequate literature search to identify studies that assessed the diagnostic accuracy of TE in CHB patients using biopsy as reference standard. Hierarchical summary receiver-operating curves model and the bivariate mixed-effects binary regression model were applied to generate summary receiver-operating characteristic curves and pooled estimates of sensitivity and specificity. Results. The area under the summary receiver-operating curve for significant fibrosis and cirrhosis was 0.86 (95% confidence interval (CI): 0.83–0.89) and 0.92 (95% CI: 0.90–0.94), respectively. The sensitivity, specificity, and diagnostic odds ratio of TE for significant fibrosis were 0.78 (95% CI: 0.73–0.81, p<0.01; I2=85.59%), 0.81 (95% CI: 0.77–0.84, p<0.01; I2=88.20%), and 14.44 (95% CI: 10.80–19.31, p<0.01; I2=100%) and for cirrhosis were 0.84 (95% CI: 0.80–0.88, p<0.01; I2=76.67%), 0.87 (95% CI: 0.84–0.90, p<0.01; I2=90.89%), and 36.63 (95% CI: 25.38–52.87, p<0.01; I2=100%), respectively. The optimal cut-off values of TE were 7.25 kPa for diagnosing significant fibrosis and 12.4 kPa for diagnosing cirrhosis, respectively. Conclusion. TE is of great value in the detection of patients with CHB-related cirrhosis but has a suboptimal accuracy in the detection of significant fibrosis.

scholarly journals Correlation between APRI, FIB-4 and GPR Indices to Fibroscan and HBeAg Status in Patients with Chronic Hepatitis B

2021 ◽  
Vol 27 (3) ◽  
pp. 320
Author(s):  
Rina Erlina ◽  
Puspa Wardhani ◽  
Yessy Puspitasari ◽  
Ulfa Kholili
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Hepatitis B ◽  
Chronic Hepatitis B ◽  
Transient Elastography ◽  
Clinical Chemistry ◽  
Serum Markers ◽  
Gamma Glutamyl Transpeptidase ◽  
Positive Hbeag ◽  
Hbeag Status

Liver fibrosis is a complication of chronic hepatitis B. Early detection of liver fibrosis is important for therapy. The aspartate aminotransferase index (AST)-to-platelet ratio index (APRI) and the fibrosis index based on 4 factors (FIB-4) in chronic hepatitis B have been widely studied despite the inconsistent results. Research on other serum markers is extensively carried out, including Gamma-Glutamyl Transpeptidase (GGT)-to-platelet ratio (GPR). Previous studies have shown that the GPR index was more accurate than APRI and FIB-4. HBeAg status is an indication for therapy. There have not been many studies on the correlation of serum markers with HBeAg status. This study aimed to determine the correlation of APRI, FIB-4, and GPR with Fibroscan and HBeAg status in chronic hepatitis B patients. A cross-sectional study was carried out from June to September 2020 and found 50 chronic hepatitis B patients. Platelet count was measured using a Sysmex XN-1000 hematology device; AST, alanine aminotransferase (ALT), and GGT levels were measured using the Dimension RXL clinical chemistry device; and the degree of fibrosis was determined using transient elastography (Fibroscan). Spearman correlation test was used in this study for the correlation analysis. The results showed a significant correlation between APRI, FIB-4 and GPR indices with Fibroscan (r=0.454, p 0.001; r=0.610, p < 0.001; r=0.540, p < 0.001, respectively). A significant correlation was found between APRI, FIB-4 and GPR indices with negative (-) HBeAg (r=0.486, p 0.004; r=0.648, p < 0.001; r=0.595, p < 0.001, respectively). In addition, a significant correlation was found between FIB-4 and positive (+) HBeAg (r=0.499, p 0.049), but no correlation was found between APRI and GPR with positive (+) HBeAg (r=0.295, p 0,267; r=0.386, p 0.140, respectively).

scholarly journals A209 NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS USING APRI, FIB-4, AND TRANSIENT ELASTOGRAPHY IN CHRONIC HEPATITIS B PATIENTS

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 239-240
Author(s):  
D H Little ◽  
S Fischer ◽  
S K Fung
Keyword(s):  
Chronic Hepatitis ◽  
Liver Fibrosis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Chronic Hepatitis B ◽  
Transient Elastography ◽  
Hbv Dna ◽  
Advanced Fibrosis ◽  
Predictive Values ◽  
Non Invasive

Abstract Background Accurate assessment of liver fibrosis is important to identify patients with chronic hepatitis B (CHB) who require antiviral therapy. As liver biopsy is invasive and costly, non-invasive tests of liver fibrosis are increasingly being used. Aims We aimed to evaluate the performance of the aspartate aminotransferase-to-platelet ratio index (APRI), Fibrosis 4 index (FIB-4), and transient elastography (TE) in predicting fibrosis in patients with CHB. Methods We retrospectively analyzed a prospectively enrolled cohort of consecutive adults with CHB who underwent liver biopsy for routine clinical indications (ALT &gt; ULN and HBV DNA &gt; 2,000 IU/ml) from January 2018 to December 2019. Demographic information, routine biochemistry, HBV serology including HBV DNA, abdominal ultrasound, fibrosis stage by liver biopsy and TE data were collected. Positive predictive values (PPV) and negative predictive values (NPV) were calculated using published cut-off values with liver biopsy as the reference standard. Results Fifty-five patients of Asian ethnicity (mean age 46 years, 65% male) were included. Most patients were HBeAg-negative (67%) and treatment-naïve (80%). Eleven (20%) patients had advanced fibrosis (F3-F4 METAVIR) and 4 (7%) patients had cirrhosis (F4). APRI &lt;0.50 had a NPV of 73% for significant fibrosis (F2-F4) and APRI &gt;1.50 had a PPV of 33% for significant. All 4 patients with cirrhosis were misclassified as having no cirrhosis with an APRI &lt;1. FIB-4 &lt;1.45 had a NPV of 90% for advanced fibrosis (F3-F4). No patient, including 11 patients with advanced fibrosis, had a FIB-4 above the cut-off value to detect advanced fibrosis (&gt;3.25). TE data was available for 38 patients. TE &lt;7.25 kPa had a NPV of 78% for significant fibrosis and TE &gt;12.4 kPa had a PPV of 50% for cirrhosis. Conclusions In Asian patients with CHB and a low prevalence of advanced fibrosis or cirrhosis, APRI, FIB-4, and TE performed well in excluding those with advanced fibrosis but were unable to accurately identify those with significant/advanced fibrosis and cirrhosis. Further studies with larger numbers of CHB patients are needed to confirm our results. Funding Agencies None

scholarly journals A Simple Noninvasive Model to Predict Significant Fibrosis in Children with Chronic Hepatitis B

2020 ◽  
Author(s):  
Kang-Ling Zhang ◽  
Xiu-Qi Chen ◽  
Zi-Li Lv ◽  
Li Huang ◽  
Xiang Yun ◽  
...  
Keyword(s):  
Chronic Hepatitis ◽  
Hepatitis B ◽  
Liver Biopsy ◽  
Receiver Operating Characteristic ◽  
Chronic Hepatitis B ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Operating Characteristics ◽  
Significant Fibrosis ◽  
Receiver Operating

Abstract Background: To develope a noninvasive model for significant fibrosis in children with chronic hepatitis B (CHB). Methods: A total 116 CHB pediatric patientswere who had undergone liver biopsy were included in the study. The gold standard of fibrosis was assessed by liver histology. blood routine examination, coagulation function, liver biochemistry, viral serology and viral load were analyzed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values.Results: Based on the correlation and difference analysis, 7 available clinical parameters [Total bile acid (TBA), Gamma-glutamyl transpeptidase(GGT)，Aspartate transaminase(AST)，Direct bilirubin to total bilirubin ratio (D/T)，Alanine aminotransferase(ALT)，Prealbumin，(PA)，and Cholinesterase（CHE）were included for modeling analysis. A model to predict significant liver fibrosis (Ishak fibrosis score ≥2) was derived using the two best parameters (PA and GGT) The original model was. After mathematical calculation, the G index 600×GGT/PA2 predicts significant fibrosis with an area under the receiving operating characteristics (AUROC) curve of 0.733，95% IC (0.643-0.811). The area under the receiver operating characteristic curve (AUROC) of G index (0.733,) was higher than that of APRI (0.680) and FIB-4(0.601) to predict significant fibrosis in children with CHB. If the G index's values outside 0.28-1.16, 52% of children with CHB could avoid liver biopsy with an overall accuracy of 75%.Conclusions: The G index can predict and exclude significant fibrosis in children with HBV, which may reduce the liver biopsy need for children with CHB.

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