A Scoring System for Predicting Significant Fibrosis in Chronic Hepatitis B Patients With Normal or Mildly Elevated Alanine Aminotransferase Levels

Wang, Hong; Yan, Rong; Yin, Zhihua; Wang, Mingshan; Ruo, Guo-Qin; Cheng, Meijuan

doi:10.1097/mcg.0000000000000090

Cited by 11 publications

(19 citation statements)

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“…37 An increased AST level with progression of liver fibrosis had been previously reported in a study of 283 CHB patients with ALT < 2ULN, which noted that AST levels were independent predictors for significant fibrosis. 7 Our findings were consistent with results from previous studies, which indicated that AST level was a better predictor of moderate or severe inflammation or significant fibrosis than ALT.…”

Section: Discussionsupporting

confidence: 93%

“…Recently, the development of noninvasive approaches for predicting liver inflammation or fibrosis based on LSM and serum markers, either alone or in combination, such as AST‐to‐ALT ratio (AAR) and aspartate aminotransferase‐to‐platelet ratio index (APRI), decreases the need of liver biopsy . However, all approaches are used to detect inflammation or fibrosis separately, rather than simultaneously . Furthermore, only a few articles have evaluated the performance of noninvasive models and there is no approach that is associated with antiviral therapy decision‐making in CHB patients with ALT < 2ULN …”

Section: Introductionmentioning

confidence: 99%

“…6 However, all approaches are used to detect inflammation or fibrosis separately, rather than simultaneously. 7,8 Furthermore, only a few articles have evaluated the performance of noninvasive models and there is no approach that is associated with antiviral therapy decision-making in CHB patients with ALT < 2ULN. 9 Therefore, in this prospectively multi-centre study, we aimed to search for clinical noninvasive markers to accurately identify moderate or severe inflammation and significant fibrosis synchronously and explore combination of markers on whether diagnostic value can be improved, which can aid antiviral therapy decision-making in CHB patients with ALT < 2ULN.…”

Section: Introductionmentioning

confidence: 99%

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Clinical noninvasive markers for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase less than two times upper limit of normal

Zhao

Dong

Wang

2018

Journal of Viral Hepatitis

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Summary Liver biopsy is the reference method for antiviral therapy decision‐making in chronic hepatitis B (CHB) when alanine aminotransferase (ALT) is less than two times of upper limit of normal (<2ULN). Our aim was to explore noninvasive markers for antiviral therapy decision in CHB with ALT <2ULN. A total of 452 treatment‐naïve CHB patients with ALT < 2ULN who had undergone liver biopsy were analysed in this prospective multi‐centre study. If liver biopsy showed moderate or severe inflammation (histology activity index ≥ 5) or significant fibrosis (Ishak fibrosis score ≥ 3), antiviral treatment was recommended. We analysed data using univariate and multivariate analyses and receiver operating characteristic curves (ROC). Two hundred and sixty‐nine (59.5%) of 452 cases with ALT < 2ULN had moderate, severe or significant inflammation. Aspartate aminotransferase (AST) (P = 0.03), anti‐hepatitis B virus core antibody (anti‐HBc) (P = 0.003) and liver stiffness measurement (LSM) (P = 0.000) were independent variables for antiviral therapy decision‐making, with area under the ROC curve (AUROC) of 0.718, 0.703 and 0.819, respectively. Our novel AAF index, which combined AST, anti‐HBc and LSM, showed better performance with AUROC of 0.876, 0.877 and 0.876 in estimation, validation and total set. Finally, 247 (54.6%) of 452 patients could avoid liver biopsy based on AAF index. Furthermore, performances of 23 noninvasive models were unsatisfactory for antiviral therapy decision with AUROC < 0.800, which were inferior to AAF index. In conclusion, AST, anti‐HBc and LSM were related to antiviral therapy decision‐making among CHB patients with ALT < 2ULN. Thus, the novel AAF index was a more reliable noninvasive model for antiviral therapy decision‐making.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Clinical noninvasive markers for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase less than two times upper limit of normal

Zhao

Dong

Wang

2018

Journal of Viral Hepatitis

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“…However, in CHB patients with ALT < 2 × ULN, few non-invasive approaches have been developed to evaluate liver fibrosis[14,19-21]. …”

Section: Introductionmentioning

confidence: 99%

Ceruloplasmin, a reliable marker of fibrosis in chronic hepatitis B virus patients with normal or minimally raised alanine aminotransferase

Zeng

Dong

Jiang

et al. 2016

WJG

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AIMTo develop a non-invasive model to evaluate significant fibrosis and cirrhosis by investigating the association between serum ceruloplasmin (CP) levels and liver fibrosis in chronic hepatitis B (CHB) patients with normal or minimally raised alanine aminotransferase (ALT).METHODSSerum samples and liver biopsy were obtained from 193 CHB patients with minimally raised or normal ALT who were randomly divided into a training group (n = 97) and a validation group (n = 96). Liver histology was evaluated by the METAVIR scoring system. Receiver operator characteristic curves were applied to the diagnostic value of CP for measuring liver fibrosis in CHB patients. Spearman rank correlation analyzed the relationship between CP and liver fibrosis. A non-invasive model was set up through multivariate logistic regression analysis.RESULTSSerum CP levels individualized various fibrosis stages via area under the curve (AUC) values. Multivariate analysis revealed that CP levels were significantly related to liver cirrhosis. Combining CP with serum GGT levels, a CG model was set up to predict significant fibrosis and liver cirrhosis in CHB patients with normal or minimally raised ALT. The AUC, sensitivity, specificity, positive predictive value, and negative predictive value were 0.84, 83.1%, 78.6%, 39.6%, and 96.5% to predict liver cirrhosis, and 0.789, 80.26%, 68.38%, 62.25%, and 84.21% to predict significant fibrosis. This model expressed a higher AUC than FIB-4 (age, ALT, aspartate aminotransferase, platelets) and GP (globulin, platelets) models to predict significant fibrosis (P = 0.019 and 0.022 respectively) and revealed a dramatically greater AUC than FIB-4 (P = 0.033) to predict liver cirrhosis.CONCLUSIONThe present study showed that CP was independently and negatively associated with liver fibrosis. Furthermore, we developed a novel promising model (CG), based on routine serum markers, for predicting liver fibrosis in CHB patients with normal or minimally raised ALT.

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“…Some studies have shown that AST has better diagnostic performance than ALT in predicting hepatic necrotizing in ammation [17]. As an independent factor to predict signi cant brosis, AST level increased with the aggravation of liver brosis [21]. Some of the delay clearance in AST was related to ALT level [22], and some of the advanced liver brosis was related to mitochondrial damage [23].…”

Section: Discussionmentioning

confidence: 99%

A Noninvasive Model to Predict Liver Histology for Antiviral Therapy Decision in Chronic Hepatitis B with Alanine Aminotransferase＜2 Upper Limit of Normal

Chen

Huang

2020

Preprint

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Background and Aim: Although liver biopsy is currently the gold standard to evaluate liver histology, it has many limitations, such as sampling error, cost and risk of complications. This study aims to construct a noninvasive model to predict liver histology for antiviral therapy in chronic hepatitis B (CHB) with alanine aminotransferase (ALT)＜2 times upper limit of normal(ULN).Methods: We retrospectively analyzed 577 patients with CHB who received liver biopsy and whose ALT was less than 2 ULN. Then they were randomly divided into a training group and a validation group. Through logistic regression analysis, a novel predictive model was constructed in the training group to predict significant changes in liver histology [necro-inflammatory activity grade (G) ≥2 or fibrosis stage (S) ≥2] and then validated in the validation group.Results: If liver biopsy showed moderate or severe inflammation or significant fibrosis, antiviral treatment was recommended. Aspartate aminotransferase (AST), anti-hepatitis B virus core antibody (anti-HBC) and glutamine transpeptidase (GGT) were identified as independent predictors for antiviral therapy, with area under the ROC curve (AUROC) of 0.649, 0.647 and 0.616, respectively. Our novel model index, which combined AST, anti- HBC and GGT with AUROC of 0.700 and 0.742 in estimation set and validation set.Conclusions: This study established a noninvasive model to predict liver histology for antiviral treatment decision in patients with CHB with ALT < 2 ULN, which can reduce the clinical needs of liver biopsy.

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A Scoring System for Predicting Significant Fibrosis in Chronic Hepatitis B Patients With Normal or Mildly Elevated Alanine Aminotransferase Levels

Cited by 11 publications

References 1 publication

Clinical noninvasive markers for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase less than two times upper limit of normal

Clinical noninvasive markers for antiviral therapy decision in chronic hepatitis B with alanine aminotransferase less than two times upper limit of normal

Ceruloplasmin, a reliable marker of fibrosis in chronic hepatitis B virus patients with normal or minimally raised alanine aminotransferase

A Noninvasive Model to Predict Liver Histology for Antiviral Therapy Decision in Chronic Hepatitis B with Alanine Aminotransferase＜2 Upper Limit of Normal

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