A novel index using routine clinical parameters for predicting significant liver inflammation in chronic hepatitis B

Abstract

Identifying the degree of liver inflammation is critical for therapeutic judgement of patients with chronic hepatitis B (CHB). However, we lack indexes which can accurately predict significant liver inflammation in patients with CHB. This study aimed to develop a simple predictive index for liver inflammation in CHB using routine clinical parameters. A total of 519 patients with CHB who underwent liver biopsy were enrolled and randomly divided into training (n = 346) and validation cohorts (n = 173). Based on routine clinical parameters, gamma-glutamyl transpeptidase (GGT; P = 0.031) and platelets (PLT; P < 0.001) were identified as independent predictors of significant inflammation by multivariable analysis in the training cohort. Accordingly, the GGT to PLT ratio (GPR) was developed to amplify the opposing effects for predicting liver inflammation. In the training cohort, the AUCs of GPR in predicting significant inflammation were 0.791 (95% CI: 0.742-0.839), 0.783 (95% CI: 0.717-0.849) and 0.791 (95% CI: 0.716-0.867) in the entire patients with CHB, HBeAg-positive CHB patients and HBeAg-negative CHB patients, respectively. The diagnostic performance of GPR for significant inflammation was significantly superior to that of alanine aminotransferase (ALT), aspartate transaminase (AST) and GGT in all patients with CHB and HBeAg-positive CHB patients, but was comparable with ALT, AST and GGT in HBeAg-negative CHB patients. In the validation cohort, the diagnostic performance of GPR in assessing significant liver inflammation was also superior to other indexes in all patients with CHB and HBeAg-positive CHB patients, but was comparable with GGT in HBeAg-negative CHB patients. Thus, GPR can be a novel and simple index for predicting significant liver inflammation in CHB, especially for HBeAg-positive CHB.

Presence of Liver Inflammation in Asian Patients With Chronic Hepatitis B With Normal ALT and Detectable HBV DNA in Absence of Liver Fibrosis

“…Previous studies have shown that serum GGT levels are independently associated with significant liver inflammation in patients with CHB. ( 36 , 37 , 38 , 39 ) In the present study, elevated GGT levels were also identified as the risk factor for the presence of significant inflammation in patients with CHB with detectable HBV DNA. As previously reported, age is significantly associated with liver inflammation activity in patients with CHB.…”

Letter: rates and determinants of significant liver inflammation in chronic hepatitis B virus‐infected patients with low ALT levels in the absence of significant fibrosis—authors' reply

“…3 For example, platelet count was previously reported to be associated with inflammatory activity. 4 A similar relationship was found in our cohort in univariate analysis, but this association was lost upon adjustment for the extent of liver fibrosis. This suggests that the degree of liver fibrosis, rather than platelet count itself, is the driver of the previously proposed association.…”

Up-regulation of RIP1 and IPS-1 in chronic HBV infected patients

“…As all of the patients who participated in the current investigation had normal ranges of liver function markers, there was no relationship between IPS-1 and RIP1 mRNA levels and serum levels of liver function markers were not significant. However, previous investigations revealed that AST is a critical marker of liver inflammation, which may be associated with liver cirrhosis and HCC (Wang et al , 2018). Due to the positive correlation between AST and IPS-1, it may be hypothesized that IPS-1 is an inducer of liver inflammation.…”