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Predictors for significant hepatic fibrosis in chronic HBV patients in daily clinical practice: A prospective study
Fadi Abu Baker1, Saif Abu Mouch1, Dorin Nicola1
1Department of Gastroenterology and Hepatology, Hillel Yaffe Medical Center, Affiliated to the Technion Faculty of Medicine, Haifa, Israel.
Insights
Simple clinical factors like age over 50, elevated ALT, high HBV DNA, diabetes, steatosis, and heavy smoking predict significant liver fibrosis in chronic hepatitis B patients, aiding clinical practice.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Accurate assessment of liver fibrosis is crucial for managing chronic hepatitis B (CHB).
- Current diagnostic methods like liver biopsy and elastography have limitations including cost, invasiveness, and availability.
- There is a need for simpler methods to identify CHB patients with significant fibrosis in routine clinical settings.
Purpose of the Study:
- To identify simple clinical and laboratory predictors of significant liver fibrosis in patients with chronic hepatitis B.
- To develop a tool for risk stratification in resource-limited settings.
Main Methods:
- Prospective study involving 173 CHB patients undergoing shear wave elastography (SWE), abdominal ultrasound, and blood tests.
- Data collected included demographics, habits, medical history, and CHB status.
- Multivariate logistic regression analysis was used to identify independent predictors of significant fibrosis (defined by SWE).
Main Results:
- 23.0% of patients had significant liver fibrosis.
- Independent predictors identified were: age > 50 years (OR: 3.53), ALT > 40 U/L (OR: 8.16), HBV DNA > 2000 IU/mL (OR: 9.20), diabetes mellitus (OR: 3.58), moderate-to-severe steatosis on ultrasound (OR: 4.50), and heavy smoking.
- These factors demonstrated significant associations with the presence of fibrosis.
Conclusions:
- Clinical and laboratory variables can effectively identify CHB patients at high risk of significant liver fibrosis.
- These predictors can assist in prioritizing patients for further investigation and management, optimizing resource allocation.
- This approach supports improved patient care in daily practice, especially where advanced diagnostic tools are scarce.
Abstract:
Accurate knowledge of fibrosis levels is essential for effective treatment decisions and prognostication in chronic hepatitis B (CHB) infection. Current guidelines recommend liver biopsy and elastography as the most reliable methods for assessing fibrosis in CHB patients. However, these methods are not widely implemented due to the limited availability, high costs, and invasiveness of liver biopsy. Thus, we aimed to identify simple clinical predictors of significant liver fibrosis in CHB patients in daily practice. We prospectively recruited CHB patients to undergo shear wave elastography (SWE), abdominal ultrasound, and blood tests. In parallel, we extracted data on patient demographics, habits, medical backgrounds, medications, and CHB status and treatment. Multivariate logistic regression analyses were used to determine predictors of significant fibrosis. Of the 173 patients included in the final analysis, 40 (23.0%) had evidence of significant fibrosis on two-dimensional SWE. Age > 50 years (odds ratio (OR): 3.53; 95% confidence interval (CI): 1.34-9.25; p = 0.001), alanine aminotransferase > 40 (OR: 8.16; 95% CI: 4.6-15.3; p = 0.001), hepatitis B virus DNA> 2000 (OR: 9.20; 95% CI: 3.4-19.0; p < 0.001), concomitant diabetes mellitus (OR: 3.58; 95% CI: 1.89-5.49; p = 0.040), moderate-to-severe steatosis on ultrasound (OR: 4.50; 95% CI: 2.35-9.95; p = 0.014), and heavy smoking were independent predictors of significant fibrosis. In conclusion, we identified clinical and laboratory variables that may effectively identify CHB patients at high risk of significant fibrosis. These can aid in resource allocation in daily practice with limited resources.
