Total bile acid-to-cholesterol ratio as a novel noninvasive marker for significant liver fibrosis and cirrhosis in patients with non-cholestatic chronic hepatitis B virus infection

Abstract

Although serum bile acids and total cholesterol (TC) are closely related to liver cirrhosis, the potential diagnostic value of total bile acid-to-cholesterol ratio (TBA/TC) for liver fibrosis is unclear. The present study aimed to evaluate the value of TBA/TC in the diagnosis of cirrhosis and the relationship between TBA/TC and significant liver fibrosis in chronic hepatitis B virus (HBV) infected patients without cholestasis. 667 patients with alkaline phosphatase (ALP) ≤ 1.5 upper limit of normal (ULN) and gamma-glutamyl transferase (GGT) ≤ 3 ULN were rigorously included in this cross-sectional study. Liver biopsy was performed in 32 patients and METAVIR scoring system was used to evaluate liver fibrosis stage. Liver ultrasound elastography was performed in 138 patients, significant fibrosis was defined as fibrosis ≥ F2. Multiple logistic regression as well as receiver operating characteristic (ROC) curves analyses were performed. Compared to patients with non-cirrhosis, TBA and TBA/TC were significantly higher in cirrhosis while TC was significantly lower (all P < .001). In multivariate analysis, TBA/TC was also independently associated with cirrhosis [odds ratio (OR) = 1.102, 95% confidence interval (CI): 1.085–1.166]. The area under the curve (AUC) of TBA/TC (0.87) was almost equivalent to the aspartate aminotransferase to platelet ratio index (APRI, AUC = 0.84) and fibrosis 4 score (FIB-4, AUC = 0.80), and the optimal cut-off value for TBA/TC to diagnose cirrhosis was 2.70. Among the patients performed liver biopsy, TBA/TC were significantly higher both in significant fibrosis and cirrhosis as well as significantly correlated with fibrosis stage (all P < .001). Furthermore, In patients performed liver ultrasound elastography, TBA/TC was also independently associated with significant fibrosis (OR = 1.040, 95% CI: 1.001–1.078). Assessment of TBA/TC could serve as an additional marker of significant liver fibrosis and cirrhosis in non-cholestatic chronic HBV infection.

Identification of Common Genes and Pathways in Eight Fibrosis Diseases

“…GO:0051264 is connected with mono-olein metabolism. Serum bile acids and total cholesterol (TC) are closely related to liver cirrhosis; the potential diagnostic value of total bile acid-to-cholesterol ratio (TBA/TC) for liver fibrosis has been proven ( Yan et al, 2020 ).…”

Plasma fetal bile acids 7α-hydroxy-3-oxochol-4-en-24-oic acid and 3-oxachola-4,6-dien-24-oic acid indicate severity of liver cirrhosis

“…Elevated plasma bile acids, in particular, both free and conjugated CDCA, have been reported to be elevated in cirrhotic patients relative to healthy volunteers 22 . Total bile acids and total bile acids/cholesterol ratio were found to be elevated in 451 cirrhotic patients compared with 216 non-cirrhotic patients with non-cholestatic chronic HBV infection in China 23 . An investigation of 32 cirrhotic patients and 27 healthy volunteers examined 12 serum bile acids using UPLC-TQMS and reported that serum concentrations of the conjugated primary bile acids, taurocholic acid (TCA), glycocholic acid (GCA) and taurochenodeoxycholic acid (TCDCA) were positively associated with Child–Pugh classification 24 .…”

A Current Understanding of Bile Acids in Chronic Liver Disease

“…Serum TBAs are also significantly increased in cirrhosis due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infection 42,43 . Yan et al demonstrated an association of cirrhosis and serum TBAs to total cholesterol ratio in non-cholestatic chronic HBV infection 44 . Serum TBAs, particularly conjugated BAs, are elevated in HBV cirrhosis with a progressive increase as CTP grade advances 45 .…”