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Non-invasive models for predicting histology in patients with chronic hepatitis B
Chun-Tao Wai1, Chee Leong Cheng, Aileen Wee
1Department of Medicine, National University Hospital, Singapore. mdcwct@nus.edu.sg
Insights
Non-invasive models for predicting liver fibrosis in chronic hepatitis B (CHB) patients are unreliable. Existing models from chronic hepatitis C (CHC) studies showed poor accuracy in CHB patients, indicating a need for new diagnostic approaches.
Area of Science:
- Hepatology
- Gastroenterology
- Medical Diagnostics
Background:
- Chronic hepatitis B (CHB) requires accurate non-invasive methods to assess liver fibrosis and cirrhosis.
- Limited research exists on non-invasive fibrosis prediction models specifically for CHB patients.
- Existing models developed for chronic hepatitis C (CHC) may not be applicable to CHB.
Purpose of the Study:
- To evaluate non-invasive markers for diagnosing significant fibrosis and cirrhosis in CHB patients.
- To assess the accuracy of established non-invasive fibrosis models from CHC in a CHB cohort.
Main Methods:
- Histological evaluation of liver biopsies using the Ishak score in treatment-naïve CHB patients.
- Development and validation of non-invasive fibrosis markers using training and validation sets.
- Assessment of Area Under the Receiver Operating Characteristic Curve (AUROC) for various markers and models, including AST, AST/ALT ratio, and APRI.
Main Results:
- Significant fibrosis was present in 47% and cirrhosis in 19% of the 218 evaluated CHB patients.
- Platelet count was the only significant predictor of fibrosis/cirrhosis in multivariate analysis, with modest AUROC values (0.63 and 0.73).
- Non-invasive models derived from CHC studies demonstrated poor accuracy in the CHB cohort.
Conclusions:
- Non-invasive fibrosis prediction models validated in CHC patients are unsuitable for diagnosing significant fibrosis or cirrhosis in CHB patients.
- Simple, readily available non-invasive markers lack sufficient accuracy for predicting cirrhosis in CHB.
- Further research is needed to develop reliable non-invasive diagnostic tools for CHB.
Background And Aim:
In contrast to chronic hepatitis C (CHC), few studies had been performed in assessing non-invasive models for predicting significant fibrosis or cirrhosis in chronic hepatitis B (CHB) patients. We aimed to evaluate non-invasive markers for diagnosing significant fibrosis/cirrhosis in patients with CHB, and to evaluate accuracy of models from CHC in CHB patients.
Patients And Methods:
Liver biopsies from consecutive treatment-naïve CHB patients were evaluated histologically by a pathologist blindly, using the Ishak score. Patients were divided randomly into a training (65%) and a validation sets (35%). Markers of fibrosis were evaluated by univariate followed by multivariate analysis in the training set. Area under receiver operating characteristics curve (AUROC) was assessed and validated in the training set. AUROC of aspartate aminotransferase (AST), AST/alanine aminotransferase (ALT) ratio, and AST-platelets ratio index (APRI) (derived from studies from CHC) in diagnosing significant fibrosis/cirrhosis were also assessed.
Results:
Two-hundred and eighteen CHB patients were evaluated: 83% male, 86% Chinese, 47% having significant fibrosis, 19% having cirrhosis. Platelets were the only factor significantly associated with significant fibrosis and cirrhosis at multivariate analysis but the AUROC was only modest at 0.63 and 0.73, respectively. Models derived from studies from CHC were even less accurate.
Conclusion:
Models with non-invasive markers in predicting histology from CHC patients were unsuitable for CHB patients. No variables consisting of simple and readily available markers were able to predict cirrhosis accurately in patients with CHB.
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