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Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic
Jian Wang1, Xiaomin Yan2, Yue Yang1
1Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
Insights
A new model, APRG (alkaline phosphatase/platelets/red blood cell distribution width standard deviation/globulin), accurately predicts liver fibrosis in chronic hepatitis B patients. This noninvasive method shows superior diagnostic value compared to existing models, potentially reducing the need for liver biopsies.
Area of Science:
- Hepatology
- Biomarkers
- Diagnostic Accuracy
Background:
- Established noninvasive models for liver fibrosis in chronic hepatitis B (CHB) have inconclusive predictive performance.
- Accurate assessment of liver fibrosis is crucial for managing CHB patients and preventing disease progression.
Purpose of the Study:
- To develop and validate a novel, noninvasive predictive model for liver fibrosis in CHB patients using routine clinical parameters.
- To compare the diagnostic performance of the new model against existing noninvasive fibrosis assessment tools.
Main Methods:
- A cohort of 308 CHB patients who underwent liver biopsy was analyzed.
- Multivariable analysis identified independent predictors of significant fibrosis.
- A new predictive model, APRG (alkaline phosphatase/platelets/red blood cell distribution width standard deviation/globulin), was developed based on these predictors.
Main Results:
- Platelets, RDW-SD, ALP, and globulin were identified as independent predictors of significant fibrosis.
- The APRG model demonstrated significant diagnostic accuracy for significant fibrosis (AUROC 0.757), advanced fibrosis (AUROC 0.763), and liver cirrhosis (AUROC 0.781).
- APRG showed significantly higher AUROCs than APRI, RPR, AAR, FIB-4, and GPR for predicting various stages of liver fibrosis.
Conclusions:
- The APRG model exhibits superior diagnostic value for assessing liver fibrosis in CHB patients compared to conventional noninvasive models.
- The implementation of the APRG model may decrease the requirement for liver biopsy in clinical practice for CHB management.
Objectives:
Noninvasive models have been established for the assessment of liver fibrosis in patients with chronic hepatitis B(CHB). However, the predictive performance of these established models remains inconclusive. We aimed to develop a novel predictive model for liver fibrosis in CHB based on routinely clinical parameters.
Results:
Platelets(PLT), the standard deviation of red blood cell distribution width(RDW-SD), alkaline phosphatase(ALP) and globulin were independent predictors of significant fibrosis by multivariable analysis. Based on these parameters, a new predictive model namely APRG(ALP/PLT/RDW-SD/globulin) was proposed. The areas under the receiver-operating characteristic curves(AUROCs) of APRG index in predicting significant fibrosis(≥F2), advanced fibrosis(≥F3) and liver cirrhosis(≥F4) were 0.757(95%CI 0.699 to 0.816), 0.763(95%CI 0.711 to 0.816) and 0.781(95%CI 0.728 to 0.835), respectively. The AUROCs of the APRG were significantly higher than that of aspartate transaminase(AST) to PLT ratio index(APRI), RDW to PLT ratio(RPR) and AST to alanine aminotransferase ratio(AAR) to predict significant fibrosis, advanced fibrosis and cirrhosis. The AUROCs of the APRG were also significantly higher than fibrosis-4 score (FIB-4) (0.723, 95%CI 0.663 to 0.783) for cirrhosis(P=0.034) and better than gamma-glutamyl transpeptidase(GGT) to PLT ratio(GPR) (0.657, 95%CI 0.590 to 0.724) for significant fibrosis(P=0.001).
Materials And Methods:
308 CHB patients who underwent liver biopsy were enrolled. The diagnostic values of the APRG for liver fibrosis with other noninvasive models were compared.
Conclusions:
The APRG has a better diagnostic value than conventionally predictive models to assess liver fibrosis in CHB patients. The application of APRG may reduce the need for liver biopsy in CHB patients in clinical practice.
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