Liver Stiffness Measurement can Predict Liver Inflammation in Chronic Hepatitis B Patients with Normal Alanine Transaminase

Background and Aims:To determine whether liver stiffness measurement(LSM)indicates liver inflammation in chronic hepatitis B(CHB)with different upper limits of normal(ULNs)for alanine aminotransferase(ALT).Methods:We grouped 439 CHB patients using different ULNs for ALT:cohort I,≤40 U/L(439 subjects);cohort II,≤35/25 U/L(males/females;330 subjects);and cohort III,≤30/19 U/L(males/females;231 subjects).Furthermore,84 and 96 CHB patients with normal ALT(≤40 U/L)formed the external and prospective validation groups,respectively We evaluated the correlation between LSM and biopsy-confirmed liver inflammation,and determined diagnostic accuracy using area under the curve(AUC).A noninvasive LSM-based model was developed using multivariate logistic regression.Results:Fibrosis-adjusted LSM values significantly increased with increasing inflammation.The AUCs of LSM in cohorts I,II,and III were 0.799,0.796,and 0.814,respectively,for significant inflammation(A≥2)and 0.779,0.767,and 0.770,respectively,for severe inflammation(A=3).Cutoff LSM values in all cohorts for A≥2and A=3 were 6.3 and 7.5 kPa,respectively.Internal,external,and prospective validations showed high diagnostic accuracy of LSM for A≥2 and A=3,and no significant differences in AUCs among the four groups.LSM and globulin independently predicted A≥2.The AUC of an LSM-globulin model for A≥2 exceeded those of globulin,ALT,and AST,but was similar to that of LSM.Conclusions:LSM predicted liver inflammation and guided the indication of antiviral therapy for CHB in patients with normal ALT.

Advantages of a Novel Model for Predicting Hepatic Fibrosis in Chronic Hepatitis B Virus Carriers Compared with APRI and FIB-4 Scores

Background and Aims:Aspartate aminotransferase-toplatelet 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.