Optimizing the Use of the Gamma-Glutamyl Transpeptidase-to-Platelet Ratio and Transient Elastography to Identify Liver Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

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.

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The gamma-glutamyl transpeptidase to platelet ratio for non-invasive assessment of liver fibrosis in patients with chronic hepatitis B and non-alcoholic fatty liver disease

Oncotarget ◽

10.18632/oncotarget.16162 ◽

2017 ◽

Vol 8 (17) ◽

pp. 28641-28649 ◽

Cited By ~ 8

Author(s):

Qiang Li ◽

Chuan Lu ◽

Weixia Li ◽

Yuxian Huang ◽

Liang Chen

Keyword(s):

Chronic Hepatitis ◽

Liver Disease ◽

Liver Fibrosis ◽

Hepatitis B ◽

Fatty Liver Disease ◽

Gamma Glutamyl Transpeptidase ◽

Alcoholic Fatty Liver ◽

Non Invasive ◽

Glutamyl Transpeptidase ◽

Alcoholic Fatty Liver Disease

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Transaminases and gamma glutamyl transpeptidase for detecting nonalcoholic steatohepatitis and fibrosis in nonalcoholic fatty liver disease

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v8i1.28923 ◽

2016 ◽

Vol 8 (1) ◽

pp. 61

Author(s):

Shahinul Alam ◽

Utpal Das Gupta ◽

Jahangir Kabir ◽

Sheikh Mohammad Noor-E-Alam ◽

Ziaur Rahman Chowdhury ◽

...

Keyword(s):

Liver Disease ◽

Fatty Liver ◽

Nonalcoholic Fatty Liver Disease ◽

Nonalcoholic Steatohepatitis ◽

Fatty Liver Disease ◽

Fibrosis Score ◽

Gamma Glutamyl Transpeptidase ◽

Nonalcoholic Fatty Liver ◽

Significant Fibrosis ◽

Glutamyl Transpeptidase

Background: Nonalcoholic steatohepatitis (NASH) and advanced fibrosis are the spectrum of nonalcoholic fatty liver disease (NAFLD) that may progress to cirrhosis.Objective: We aimed to determine the detecting capacity of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT) for NASH and significant fibrosis.Methods: Demographic and laboratory data of 502 sonologically diagnosed NAFLD patients were retrospectively analysed. Area under receiver operating characteristics curve (AUROC) was performed for NASH and fibrosis score ≥2 (significant fibrosis) with ALT, AST and GGT of 233 biopsied patients.Results: Of 502 patients ALT, AST and GGT was elevated in 252 (50.1 %), 184 (36.7%) and 138 (27.4%) respectively. There was no difference in histological activity and fibrosis score between normal and elevated ALT and AST. Forty two (40.2%) NASH and 23(20.2%) significant fibrosis had normal ALT level. GGT was differed in NASH and Non NASH (p< .005) and between significant fibrosis (p< .01) and insignificant fbrosis. To detect NASH AUROC curve ofGGT was 67.5%, whereas of ALT and AST was 55.2% and 55.7%. For significant fibrosis AUROC curve of ALT, AST and GGT was 44, 50 and 68.4 % respectively. GGT level of39.5 U/L could detect NASH with a 63% sensitivity and 65% specificity irrespective of sex. GGT 40.5U/L had 60% sensitivity and 59 % specificity to detect significant fibrosis. For fibrosis ≥2 AUROC curve was 75.4% in male.Conclusion: No optimal ALT and AST level could detect NASH and fibrosis. GGT level of 40 U/L had a better detecting capacity for NASH and fibrosis especially in male.

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Gamma‐glutamyl transpeptidase elevation is associated with metabolic syndrome, hepatic steatosis, and fibrosis in patients with nonalcoholic fatty liver disease: A community‐based cross‐sectional study

The Kaohsiung Journal of Medical Sciences ◽

10.1002/kjm2.12395 ◽

2021 ◽

Author(s):

Li‐Wei Chen ◽

Mi‐Sio Huang ◽

Yu‐Chiau Shyu ◽

Rong‐Nan Chien

Keyword(s):

Metabolic Syndrome ◽

Liver Disease ◽

Fatty Liver Disease ◽

Cross Sectional Study ◽

Sectional Study ◽

Gamma Glutamyl Transpeptidase ◽

Community Based ◽

Cross Sectional ◽

Nonalcoholic Fatty Liver ◽

Glutamyl Transpeptidase

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Transient Elastography and Ultrasonography: Optimal Evaluation of Liver Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B Concurrent with Nonalcoholic Fatty Liver Disease

BioMed Research International ◽

10.1155/2019/3951574 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Geng-lin Zhang ◽

Qi-yi Zhao ◽

Chao-shuang Lin ◽

Zhao-xia Hu ◽

Ting Zhang ◽

...

Keyword(s):

Chronic Hepatitis ◽

Liver Disease ◽

Liver Fibrosis ◽

Hepatitis B ◽

Fatty Liver Disease ◽

Transient Elastography ◽

Roc Curves ◽

Advanced Fibrosis ◽

Nonalcoholic Fatty Liver ◽

Significant Fibrosis

Background and Aims. Concordance between transient elastography (TE) and ultrasonography (US) in assessing liver fibrosis in patients with chronic hepatitis B (CHB) and concurrent nonalcoholic fatty liver disease (NAFLD) has been rarely studied. This study aimed to evaluate the individual and combined performances of TE and US in assessing liver fibrosis and cirrhosis. Patients and Methods. Consecutive CHB patients with NAFLD were prospectively enrolled. TE and US examinations were performed, with liver biopsy as a reference standard. Receiver operating characteristic (ROC) curves were obtained to evaluate the diagnostic performance. Differences between the areas under the ROC curves (AUCs) were compared using DeLong’s test. Results. TE and US scores correlated significantly with the histological fibrosis staging scores. TE was significantly superior to US in the diagnosis of significant fibrosis (AUC, 0.84 vs 0.73; P=0.02), advanced fibrosis (AUC, 0.95 vs 0.76; P<0.001), and cirrhosis (AUC, 0.96 vs 0.71; P<0.001). Combining TE with US did not increase the accuracy of detecting significant fibrosis, advanced cirrhosis, or cirrhosis (P=0.62, P=0.69, and P=0.38, respectively) compared to TE alone. However, TE combined with US significantly increased the positive predictive value for significant fibrosis when compared to TE alone. The optimal cut-off values of TE for predicting advanced fibrosis and cirrhosis were 8.7 kPa and 10.9 kPa, with negative predictive values of 92.4% and 98.7%, respectively. Conclusions. TE is useful for predicting hepatic fibrosis and excluding cirrhosis in CHB patients with NAFLD. A combination of TE and US does not improve the accuracy in assessing liver fibrosis or cirrhosis.

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