Liver Stiffness Measurement-Based Scoring System for Significant Inflammation Related to Chronic Hepatitis B

Abstract

ObjectivesLiver biopsy is indispensable because liver stiffness measurement alone cannot provide information on intrahepatic inflammation. However, the presence of fibrosis highly correlates with inflammation. We constructed a noninvasive model to determine significant inflammation in chronic hepatitis B patients by using liver stiffness measurement and serum markers.MethodsThe training set included chronic hepatitis B patients (n = 327), and the validation set included 106 patients; liver biopsies were performed, liver histology was scored, and serum markers were investigated. All patients underwent liver stiffness measurement.ResultsAn inflammation activity scoring system for significant inflammation was constructed. In the training set, the area under the curve, sensitivity, and specificity of the fibrosis-based activity score were 0.964, 91.9%, and 90.8% in the HBeAg(+) patients and 0.978, 85.0%, and 94.0% in the HBeAg(−) patients, respectively. In the validation set, the area under the curve, sensitivity, and specificity of the fibrosis-based activity score were 0.971, 90.5%, and 92.5% in the HBeAg(+) patients and 0.977, 95.2%, and 95.8% in the HBeAg(−) patients. The liver stiffness measurement-based activity score was comparable to that of the fibrosis-based activity score in both HBeAg(+) and HBeAg(−) patients for recognizing significant inflammation (G ≥3).ConclusionsSignificant inflammation can be accurately predicted by this novel method. The liver stiffness measurement-based scoring system can be used without the aid of computers and provides a noninvasive alternative for the prediction of chronic hepatitis B-related significant inflammation.

Noninvasive scoring system for significant inflammation related to chronic hepatitis B

“…Theoretically, the multiplication or division of two variables would gain more powerful discernibility than any one of the included variables. It has been indicated in our previous research that patients with significant inflammation tended to have higher AST and GGT levels, and have lower CHE, Alb, and PreAlb levels14. As was shown in the research by Pan et al .,24 PLT was significantly negatively related to the degree of liver inflammation, which was in accordance with the finding by Shoaei et al 25…”

“…In our previous study, we reported an LSM-based model for significant inflammation, which had nearly perfect AUCs of 0.971 and 0.977 in the HBeAg (+) and HBeAg (−) patients, respectively14. If FibroScan is available, significant inflammation can be precisely predicted.…”

“…Histological scores were calculated and confirmed by a panel of pathologists in case of disagreement between the two pathologists with regard to the pathological diagnosis. Patients were divided into two groups according to the Scheuer scale (G 0, 1, and 2, and G 3 and 4) 14 .…”

“…Several models have been proposed for the prediction of inflammatory activity related to CHB 10 11 12 13 . Recently, we reported an LSM-based prediction model for inflammatory activity related to CHB, which has high accuracy with balanced sensitivity and specificity 14 .…”

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

“…Hong et al. developed a novel prediction model based on the detection of liver stiffness measurement for inflammatory activity related to CHB, which has high accuracy with balanced sensitivity and specificity . However, FibroScan is rarely available in the resource‐limited areas.…”