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Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Advantages of a Novel Model for Predicting Hepatic Fibrosis in Chronic Hepatitis B Virus Carriers Compared with APRI
Na-Ling Kang1, Qing-Fa Ruan2, De-Sheng Zhang3
1Department of Hepatology, Hepatology Research Institute, The First Affiliated Hospital, Fujian Medical University, Fuzhou, Fujian, China.
Insights
The GPSA model accurately diagnoses liver fibrosis in chronic hepatitis B virus (HBV) carriers, even with varying normal alanine aminotransferase (ALT) levels. This new model outperforms APRI and FIB-4 for predicting significant fibrosis.
Area of Science:
- Hepatology
- Virology
- Diagnostic marker development
Background:
- Aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) are common non-invasive markers for liver fibrosis in chronic hepatitis B virus (HBV) infection.
- The definition of normal alanine aminotransferase (ALT) levels varies, impacting the reliability of existing fibrosis assessment tools.
Purpose of the Study:
- To evaluate the diagnostic performance of APRI and FIB-4 in chronic HBV carriers with different upper limits of normal (ULNs) for ALT.
- To develop and validate a novel liver fibrosis predictive model for chronic HBV carriers.
Main Methods:
- 581 chronic HBV carriers were stratified into four groups based on varying ALT ULNs.
- An external validation cohort of 106 chronic HBV carriers was utilized.
- The GPSA (gamma glutamyl transpeptidase, platelet count, HBsAg, albumin) model was developed using multivariate logistic regression and its predictive value assessed via area under the curve (AUC).
Main Results:
- The GPSA model demonstrated superior diagnostic value for significant fibrosis and cirrhosis across all four groups compared to APRI and FIB-4.
- AUCs for significant fibrosis using GPSA ranged from 0.857 to 0.905, and for cirrhosis from 0.901 to 0.913.
- GPSA showed consistent high performance in internal and external validation groups, with AUCs for significant fibrosis around 0.87.
Conclusions:
- The GPSA model provides accurate diagnosis of liver fibrosis in chronic HBV carriers.
- The GPSA model is effective across different definitions of normal ALT levels, offering a reliable tool for fibrosis assessment.
Background And Aims:
Aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) are widely used to assess liver fibrosis in chronic hepatitis B virus (HBV) infection. Currently, the definition of normal alanine aminotransferase (ALT) is controversial. We aimed to examine the diagnostic value of APRI and FIB-4 in chronic HBV carriers with different upper limits of normal (ULNs) for ALT.
Methods:
581 chronic HBV carriers were divided into the following four groups based on different ULNs for ALT: chronic HBV carriers I, II, III, and IV. Furthermore, 106 chronic HBV carriers formed an external validation group. Predictive values of APRI and FIB-4 were elucidated using the area under the curve (AUC). A liver fibrosis-predictive model-GPSA (named for its measure of gamma glutamyl transpeptidase, platelet count, HBsAg and albumin) was developed using multivariate logistic regression analysis.
Results:
In chronic HBV carriers I, the AUCs of APRI and FIB-4 were 0.680 and 0.609 for significant fibrosis and 0.678 and 0.661 for cirrhosis, respectively. The AUCs of GPSA for significant fibrosis in the training group, internal group, and external validation group were 0.877, 0.837, and 0.871, respectively. The diagnostic value of GPSA differed among chronic HBV carriers I, II, III, and IV, with AUCs for significant fibrosis being 0.857, 0.853, 0.868, and 0.905 and AUCs for cirrhosis being 0.901, 0.905, 0.886, and 0.913, respectively. GPSA showed a higher diagnostic value than APRI and FIB-4 for predicting significant fibrosis in the four groups.
Conclusions:
The GPSA model allows for accurate diagnosis of liver fibrosis in chronic HBV carriers with different ULN for ALT.
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