Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B

Abstract 

Background Aims: Liver biopsy is the gold standard for assessing hepatitis B virus (HBV)-related histology. The aim was to determine the diagnostic utility of noninvasive serum markers in patients with chronic hepatitis B.

Methods: The aminotransferases and indices including α₂-macroglobulin, apolipoprotein A1, haptoglobin, γ-glutamyl-transpeptidase (GGT), and total bilirubin (Fibrotest), and ALT (Actitest) were compared with liver histology. The primary outcomes were A2–A3 activity and F2–F4 fibrosis (METAVIR).

Results: Two hundred and nine patients were included. Forty-one patients (20%) had A2–A3 activity and 61 (29%) had F2–F4 fibrosis. AST and GGT (P<0.001) were independently associated with A2–A3 activity. AST, ALT, and Actitest accurately predicted activity ((areas under receiver operating characteristic (ROC) curves (AUROC), 0.81–0.82±0.04)); an AST or ALT≤30IU/l excluded significant activity with 96% certainty. Fibrotest accurately predicted F2–F4 fibrosis (AUROC, 0.78±0.04). Fibrotest scores (range, 0–1.0) ≤0.20 and >0.80 had negative and positive predictive values of 92%, respectively. Restricting biopsy to patients with intermediate scores (>0.20 and ≤0.80) may prevent liver biopsies in 46% of patients while maintaining 92% accuracy.

Conclusions: The aminotransferases and an index including five biochemical markers are accurate noninvasive markers of HBV-related activity and fibrosis, respectively.

Keywords:  α-Macroglobulins, Apolipoprotein A1, Biopsy, Diagnosis, Fibrosis, Haptoglobins, Histology, Hepatitis B, Receiver operating characteristic curve, Transaminases

Abbreviations:  HBV, hepatitis B virus, AST, aspartate aminotransferase, ALT, alanine aminotransferase, GGT, γ-glutamyl-transpeptidase, HBsAg, hepatitis B surface antigen, HDV, hepatitis D virus, HBeAg, hepatitis Be antigen, PPV, positive predictive value, NPV, negative predictive value, AUROC, area under the receiver operating characteristic curve, IQR, interquartile range