Identification of chronic hepatitis B patients without significant liver fibrosis by a simple noninvasive predictive model.
OBJECTIVE
Histological assessment of liver fibrosis is important in the management of chronic hepatitis B (CHB) infection but poorly accepted by patients because of its invasiveness. The aim of this study was to develop a noninvasive model to assess liver fibrosis in CHB patients using clinical and routine laboratory data.


METHODS
This was a retrospective study on 235 treatment-naive viremic CHB patients. Univariate analysis of data from the training cohort (n = 150) followed by multivariate logistic regression were performed to identify independent predictors of significant fibrosis and generate predictive models. The models were validated with the remaining patients or validation cohort (n = 85) and by receiver operating characteristics (ROC) analysis.


RESULTS
Body mass index (BMI), platelet count, serum albumin, and total bilirubin levels were identified as independent predictors of bridging fibrosis or cirrhosis (Ishak stage 3-6). ROC analysis was performed using the predictive probabilities derived from the regression models. The area under the ROC curve of the best model was 0.803 (95% CI: 0.729-0.878) for the training cohort, 0.765 (95% CI: 0.644-0.885) for the validation cohort, and 0.791 (95% CI: 0.728-0.854) for the entire cohort. Using the low cut-off probability of 0.15, significant fibrosis could be excluded in 83 patients of the total patient population (negative predictive value 0.92).


CONCLUSIONS
Our noninvasive model comprising BMI and three routine laboratory tests was accurate in predicting absence of significant fibrosis. Application of this model could provide useful additional information on the stage of disease, guide future management decisions, and potentially decrease the need for liver biopsy in some CHB patients.
Hui
Alex Yui
AY
Department of Medicine & Therapeutics and Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
Chan
Henry Lik-Yuen
HL
Wong
Vincent Wai-Sun
VW
Liew
Choong-Tsek
CT
Chim
Angel Mei-Ling
AM
Chan
Francis Ka-Leung
FK
Sung
Joseph Jao-Yiu
JJ
D000328:Adult; D001663:Bilirubin / Q000097:blood; D015992:Body Mass Index; D005260:Female; D019694:Hepatitis B, Chronic / Q000175:diagnosis*; D006801:Humans; D008103:Liver Cirrhosis; D016015:Logistic Models; D008297:Male; D010976:Platelet Count; D012372:ROC Curve; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
D012709:Serum Albumin; D001663:Bilirubin