Related Experiment Video
Updated: Jun 7, 2025
Author Spotlight: Advancements and Challenges in Hepatitis B Virus Detection
Published on: December 15, 2023
Accuracy of International Guidelines in Identifying Normal Liver Histology in Chinese Patients With HBeAg-Positive
Yidi Jia1, Xun Qi2, Xueping Yu3
1Department of Infectious Diseases, Shanghai Key Laboratory of Infectious Diseases and Biosafety Emergency Response, Shanghai Institute of Infectious Diseases and Biosecurity, National Medical Center for Infectious Diseases, Huashan Hospital, Fudan University, Shanghai, China.
Insights
The Chinese Society of Hepatology (CSH) criteria more accurately identify patients with HBeAg-positive chronic HBV infection and no significant liver disease. Quantitative HBsAg levels improve diagnostic performance for other international guidelines.
Area of Science:
- Hepatology
- Virology
- Diagnostic Accuracy
Background:
- Hepatitis B virus (HBV) infection is a global health concern.
- Accurate identification of patients with HBeAg-positive chronic HBV infection and minimal liver disease is crucial for appropriate management.
- Existing international guidelines have varying diagnostic performance.
Purpose of the Study:
- To evaluate and compare the diagnostic accuracy of international guideline criteria for identifying HBeAg-positive chronic HBV infection patients with no significant liver disease.
- To assess the impact of quantitative HBsAg levels on diagnostic performance.
Main Methods:
- Retrospective analysis of 1108 HBeAg-positive chronic HBV patients.
- Comparison of diagnostic criteria from EASL (2017), AASLD (2018), APASL (2015), and CSH (2022).
- Evaluation of liver disease (G0-1) and fibrosis (S0-1) staging, and assessment of predictive values (AUC).
Main Results:
- The CSH criteria identified a higher proportion of patients with G0-1 and S0-1 (82.9%) compared to EASL (75.9%), AASLD (75.3%), and APASL (58.8%).
- CSH criteria showed significantly higher predictive value (AUC 0.782) than EASL (0.765), AASLD (0.749), and APASL (0.720).
- Incorporating quantitative HBsAg levels (> 104 IU/mL) improved the diagnostic performance of EASL, AASLD, and APASL criteria.
Conclusions:
- The CSH guideline thresholds demonstrate superior accuracy in identifying Chinese HBeAg-positive patients with no significant liver disease.
- Quantitative HBsAg levels are important for evaluating HBeAg-positive chronic HBV infection.
- Guideline recommendations may need to be tailored based on regional patient populations and the inclusion of quantitative markers.
Abstract:
We evaluated the diagnostic accuracy of various international guideline criteria for identifying HBeAg-positive chronic HBV infection patients with no significant liver disease. A total of 1108 HBeAg-positive CHB patients were retrospectively enrolled. The guidelines assessed included those from the European Association for the Study of the Liver (EASL) 2017, the American Association for the Study of the Liver Disease (AASLD) 2018, the Asian Pacific Association for the Study of the Liver (APASL) 2015 and the Chinese Society of Hepatology (CSH) 2022. The CSH criteria demonstrated a higher proportion of patients with G0-1 and S0-1 (82.9%) compared to the EASL (75.9%), AASLD (75.3%) and APASL groups (58.8%). Additionally, the CSH criteria exhibited a significantly higher predictive value (AUC 0.782, 95% CI 0.754-0.809) than the EASL (AUC 0.765, 95% CI 0.737-0.793), AASLD (AUC 0.749, 95% CI 0.720-0.778) and APASL (AUC 0.720, 95% CI 0.690-0.750) criteria for identifying G0-1 and S0-1. Adding quantitative HBsAg levels (> 104 IU/mL) to the EASL, AASLD and APASL criteria improved diagnostic performance. Consequently, the CSH guideline thresholds showed higher accuracy in identifying Chinese HBeAg-positive patients with no significant liver disease compared to EASL, AASLD and APASL criteria, emphasising the importance of considering quantitative HBsAg in the evaluation of HBeAg-positive chronic HBV infection.
