Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B.
OBJECTIVE
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 alpha(2)-macroglobulin, apolipoprotein A1, haptoglobin, gamma-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< or =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) < or =0.20 and >0.80 had negative and positive predictive values of 92%, respectively. Restricting biopsy to patients with intermediate scores (>0.20 and < or =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.
Myers
Robert P
RP
Department of Hepatology and Gastroenterology, Groupe Hospitalier Pitié-Salpêtrière, Paris, France.
Tainturier
Marie Hélène
MH
Ratziu
Vlad
V
Piton
Annie
A
Thibault
Vincent
V
Imbert-Bismut
Françoise
F
Messous
Djamila
D
Charlotte
Frederic
F
Di Martino
Vincent
V
Benhamou
Yves
Y
Poynard
Thierry
T
D000328:Adult; D001054:Apolipoproteins A / Q000097:blood; D015415:Biomarkers; D001706:Biopsy; D005260:Female; D005355:Fibrosis; D006242:Haptoglobins / Q000378:metabolism; D019694:Hepatitis B, Chronic / Q000097:blood* / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D000637:Transaminases / Q000097:blood; D000511:alpha-Macroglobulins / Q000378:metabolism
D001054:Apolipoproteins A; D015415:Biomarkers; D006242:Haptoglobins; D000511:alpha-Macroglobulins; D000637:Transaminases