Performance of Non-invasive Blood Parameters for Ruling Out Significant Liver Fibrosis in Patients with Chronic Hepatitis B

摘要

Background and Aims:Evaluation of significant liver fibro-sis is important for treatment decision and treatment re-sponse evaluation in patients with chronic hepatitis B. Since liver biopsy is invasive and transient elastography (TE) has limited availability, various non-invasive blood parameters need evaluation for their capabilities for detection of signifi-cant fibrosis. Methods:In this retrospective study, records of patients who had undergone liver biopsy for treatment-na?ve chronic hepatitis B were evaluated to obtain various non-in-vasive blood parameters (aspartate aminotransferase-to-pla-telet ratio index [referred to as APRI], Fibrosis-4 score [referred to as FIB-4], gamma-glutamyl transpeptidase-to-platelet ratio [referred to as GPR], and gamma-glutamyl transpeptidase-to-albumin ratio [referred to as GAR]), in ad-dition to TE, to assess significant liver fibrosis and compare these to fibrosis stage in liver biopsy. Results:A total of 113 patients were included in the study (median age 33 [inter-quartile range: 11-82 years], 74% males). Most (75%) pa-tients were HBeAg-negative. The liver biopsy revealed significant fibrosis (Ishak ≥3) in 13% of the patients and nil or mild fibrosis (Ishak<3) in 87%of the patients. TE findings were available for 85 patients, APRI and FIB-4 for 95 patients, GPR for 79 patients, and GAR for 78 patients. The median values of all the parameters were significantly higher in pa-tients with significant fibrosis, as compared to patients with non-significant fibrosis, and all the blood parameters as well as TE were able to identify patients with significant fibrosis significantly well (p<0.05). All non-invasive parameters had low positive predictive value but negative predictive value above 92%. Compared to TE, all the non-invasive blood pa-rameters had similar area under the curve for detecting sig-nificant fibrosis, with excellent negative predictive value (≥93%). Conclusions: Non-invasive blood parameters (APRI, FIB-4, GPR, and GAR) with negative predictive values above 93%are excellent parameters for ruling-out significant ;fibrosis in patients with chronic hepatitis B. These can be used at bedside in place of TE.