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Clinical Characteristics of Indeterminate Chronic Hepatitis B Patients With and Without Liver Biopsy

Ye Xiong1, Jian Wang1,2,3, Yuchen Song4

  • 1Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China.

Hepatology Research : the Official Journal of the Japan Society of Hepatology
|December 13, 2025
PubMed

Insights

Only 9.8% of chronic hepatitis B (CHB) patients in the indeterminate phase received liver biopsy. Those biopsied showed higher HBV DNA and noninvasive fibrosis scores, suggesting they may not represent the entire indeterminate CHB population.

Area of Science:

  • Hepatology
  • Virology
  • Clinical Medicine

Background:

  • Chronic hepatitis B (CHB) is a significant global health concern.
  • A considerable number of CHB patients in the indeterminate phase experience substantial liver injury.
  • Liver biopsy, a definitive diagnostic tool, is underutilized in this patient group.

Purpose of the Study:

  • To compare the clinical characteristics of CHB patients in the indeterminate phase who underwent liver biopsy versus those who did not.
  • To identify factors associated with the decision to perform liver biopsy in indeterminate CHB patients.

Main Methods:

  • Retrospective analysis of 2928 untreated CHB patients classified in the indeterminate phase according to AASLD 2018 guidelines.
  • Comparison of demographic, viral, and liver fibrosis markers between patients with and without liver biopsy.

Main Results:

  • Only 9.8% (288/2928) of indeterminate CHB patients underwent liver biopsy.
  • Patients who received a biopsy were older, had higher HBV DNA levels, and showed elevated noninvasive fibrosis scores (APRI, FIB-4) and liver stiffness.
  • Lower platelet counts and higher HBV DNA levels were significantly associated with undergoing liver biopsy.

Conclusions:

  • The low rate of liver biopsy in indeterminate CHB patients highlights a potential gap in diagnosis and management.
  • Patients undergoing biopsy represent a subgroup with potentially more advanced liver disease markers.
  • Findings from liver biopsies in this selected group should be interpreted cautiously and may not be generalizable to all indeterminate CHB patients.
Abstract

Keywords:
chronic hepatitis Bindeterminate phaseliver biopsy

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