A Novel Noninvasive Diagnostic Model of HBV-Related Inflammation in Chronic Hepatitis B Virus Infection Patients With Concurrent Nonalcoholic Fatty Liver Disease

Abstract

Background and AimsPatients with chronic hepatitis B virus infection (CBI) with concurrent nonalcoholic fatty liver disease (NAFLD) is becoming increasingly common in clinical practice, and it is quite important to identify the etiology when hepatitis occurs. A noninvasive diagnostic model was constructed to identify patients who need antihepatitis B virus (HBV) therapies [histologic activity index (HAI) ≥ 4] in patients with CBI with concurrent NAFLD by analyzing clinical routine parameters.Approach and ResultsIn total, 303 out of 502 patients with CBI with concurrent NAFLD proven by liver biopsy from January 2017 to December 2020 in the Tianjin Second People's Hospital were enrolled and they were divided into the HBV-related inflammation (HBV-I) group (HAI ≥ 4,176 cases) and the non-HBV-I group (HAI < 4,127 cases) according to hepatic pathology. The univariate analysis and multivariate logistic regression analysis were performed on the two groups of patients, and then the HBV-I model of patients with CBI with concurrent NAFLD was constructed. The areas under receiver operating characteristic curves (AUROCs) were used to evaluate the parameters of the regression formula. Another 115 patients with CBI with concurrent NAFLD proven by liver biopsy from January 2021 to January 2022 were enrolled as the validation group. There were some statistical differences in demographic data, biochemical indicators, immune function, thyroid function, virology indicator, and blood routine indicators between the two groups (P < 0.05) and liver stiffness measurement (LSM) in the HBV-I group was significantly higher than those in the non-HBV-I group (P < 0.05). While controlled attenuation parameters (CAP) in the HBV-I group were lower than those in the non-HBV-I group (P < 0.05); (2) We developed a novel model by logistic regression analysis: HBV-I = −0.020 × CAP + 0.424 × LSM + 0.376 × lg (HBV DNA) + 0.049 × aspartate aminotransferase (AST) and the accuracy rate was 82.5%. The area under the receiver operating characteristic (AUROC) is 0.907, the cutoff value is 0.671, the sensitivity is 89.30%, the specificity is 77.80%, the positive predictive value is 90.34%, and the negative predictive value is 81.89%; (3) The AUROC of HBV-I in the validation group was 0.871 and the overall accuracy rate is 86.96%.ConclusionOur novel model HBV-I [combining CAP, LSM, lg (HBV DNA), and AST] shows promising utility for predicting HBV-I in patients with CBI with concurrent NAFLD with high sensitivity, accuracy, and repeatability, which may contribute to clinical application.

A noninvasive model discriminating significant histological changes in treatment-naive chronic hepatitis B patients with normal ALT

“…However, according to clinical guidelines on HBV infection nowadays, we should take both fibrosis stage and inflammation grade into account. A noninvasive model composed of PT, AST, GGT, and anti-hepatitis B core antibody levels is valuable in predicting significant liver inflammation in CHB patients [ 28 ], however, it ignores the fibrosis stage. Conversely, another noninvasive model called CPHBV could accurately predict liver fibrosis in CHB patients with normal ALT level, regardless of liver inflammation [ 29 ].…”

Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Viral Hepatitis: The Interlink

“…Co-existing CHB infection and MAFLD are becoming increasingly common, and it is important to identify the etiology when hepatitis develops. A novel noninvasive diagnostic model has been developed using various parameters including CAP, LSM, HBV DNA, and AST in predicting HBV-related inflammation in CHB with concurrent MAFLD to identify patients who need anti-HBV therapy [123]. Uncertainty and challenges exist in the management of patients with co-existing CHB and MAFLD in the absence of long-term follow-up data.…”

Metabolic Dysfunction-Associated Fatty Liver Disease and Chronic Viral Hepatitis: The Interlink

“…Co-existing CHB infection and MAFLD are becoming increasingly common, and it is important to identify the etiology when hepatitis develops. A novel non-invasive diagnostic model is developed using various parameters including CAP, LSM, HBV DNA, and AST in predicting HBV-related inflammation in CHB with concurrent MAFLD to identify patients who need anti-HBV therapy 122 . Uncertainty and challenges exist in the management of patients with co-existing CHB and MAFLD in the absence of long-term follow up data.…”