Development and Validation of a Model to Predict Advanced Fibrosis in Chronic Hepatitis B Virus-Infected Patients with High Viral Load and Normal or Minimally Raised ALT

Abstract

Background/Aims Treating a group of chronic hepatitis B virus (HBV)-infected patients with high viral load and advanced fibrosis or cirrhosis, regardless of their serum alanine aminotransferase (ALT) levels, is recommended. The aim of this study was to derive and validate a model to predict advanced fibrosis in a cohort of patients with viral replication and normal or minimally raised ALT [ALT \ 2 9 upper normal limit (UNL)]. Methods Information was collected from 124 patients who underwent liver biopsy. The diagnostic value of predictors was judged using multivariate logistic modeling and area under the receiver operating characteristic curves (ROC area). Results Advanced fibrosis (F3 or F4 on METAVIR scoring schema) was diagnosed in 45.7% (95% CI, 34-57.4%) of the patients of the derivation set (70 patients) and in 37% (95% CI, 24.2-49.9%) of the validation set (54 patients). In the derivation set, age and aspartate aminotransferase (AST) were independent clinical predictors of advanced fibrosis. The ROC areas of this Age-AST model were 0.8 (95% CI, 0.7-0.9) in the derivation set and 0.82 (95% CI, 0.71-0.93) in the validation set, respectively. Without missing a single case, this model identified 11 patients (20%) without advanced fibrosis in the validation set. Conclusions A substantial proportion of patients with high viral load and ALT \ 2 9 UNL have advanced fibrosis. A simple model including age and AST is an easily applicable tool for physicians to guide their decisions on whether or not to perform liver biopsy in individual patients.

Serum HBsAg and HBeAg levels are associated with liver pathological stages in the immune clearance phase of hepatitis B virus chronic infection

“…A number of studies have explored the feasibility of using non-invasive tests to predict cirrhosis. These include the Fibroscan and FibroTest-ActiTest, galactose and methacetin breath tests, TE, fibrotest, cirrhosis discriminant score, AST/ALT ratio, APRI, FIB-4 and AP index (24)(25)(26)(27)(28)(29). However, certain tests are impractical to use in a clinical setting since they require expensive instrumentation or may use less common biochemical markers, including α2-macroglobulin, haptoglobin and apolipoprotein A1, or the use of specialized software for computations.…”

Serum Ceruloplasmin Levels Correlate Negatively with Liver Fibrosis in Males with Chronic Hepatitis B: A New Noninvasive Model for Predicting Liver Fibrosis in HBV-Related Liver Disease

“…Park et al [ 49 ] derived and validated a simple model of advanced fibrosis in patients with high viral load (HBV DNA) and elevated ALT, finding that age and AST were independent predictors of advanced fibrosis and sufficient to advise physicians about whether or not to perform liver biopsy. Kim et al [ 51 ] evaluated various serum markers, finding that APRI was the most useful for predicting significant fibrosis, and that the cirrhosis discriminant score (CDS) was the most useful for predicting extensive fibrosis. Comparison of hyaluronic acid, galactose and methacetin breath tests, APRI, FibroTest and FIB-4 showed that all were able to distinguish between mild and moderate fibrosis and cirrhotic and non-cirrhotic patients, but not all were useful as single tests while combinations of tests increased accuracy [ 52 ].…”