Abstract :
Background: The prognosis and management of patients with chronic hepatitis B depend on the amount
and progression of the liver fibrosis. Liver biopsy is currently the gold standard for staging of fibrosis and histological
activity, but it is poor tolerated. Noninvasive methods are now used increasingly to reduce the need for liver
biopsy. Our aim is to validate simpler model, consisting of routine laboratory markers for predicting liver fibrosis
in chronic hepatitis B patients.
Methods: Sixty patients with chronic hepatitis B virus infection who underwent liver biopsy before
anti-viral treatment at Vajira Hospital from June 2012 to January 2014 were recruited. On the day of scheduled liver
biopsy, complete laboratory tests were done. Liver histology was evaluated and grading by METARVIR scoring
system. S index (S index = 1000*GGT/(Plt*Alb2) was validated in this cohort and by receiver operating characteristics
(ROC) analysis.
Results: For predicting significant fibrosis, S index cut point value ≥ 0.771 had sensitivity 80%, specificity
44.4%, PPV 32.4%, NPV 87%, and the area under the ROC curve (AUROC) of 0.597. For predicting significant
histology (significant fibrosis and/or histological activity), the S index cut point value ≥ 0.587 had sensitivity
82.6%, specificity 35.1%, PPV 44.2%, NPV 76.7%, and AUROC 0.609. As in our study, for significant fibrosis and
significant histology diagnosis, we can reduce the need for liver biopsy by 33.34% and 27% with missed diagnosis
rate of 20% and 17% respectively.
Conclusions: The S index may be used as a screening method for considering liver biopsy in chronic
hepatitis B patients, but it had fair accuracy. |
file/Thai-Journal-of-gastroenterology-vol-15-no-3-1858323.pdf