title: Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-virus related liver disease.
abstract: OBJECTIVE
  Noninvasive markers for predicting significant fibrosis and inflammation have not yet been validated in an unselected group of chronic hepatitis B virus (HBV) carriers. The aim of this study was to create noninvasive models to predict significant fibrosis and inflammation in chronic HBV carriers.
  
  
  METHODS
  A total of 276 (229 HBeAg negative, 47 HBeAg positive) unselected consecutive treatment naïve patients chronically infected with HBV who attended our center over a 36-month period underwent liver biopsy. HBeAg negative patients were randomly divided into two cohorts: training group (N = 130) and validation group (N = 99). HBeAg positive patients were analyzed as a whole without separation. Thirteen parameters were analyzed separately in HBeAg negative and HBeAg positive patients to predict significant fibrosis (Ishak stage >or=3) and inflammation (Ishak grade >or=7).
  
  
  RESULTS
  In HBeAg negative patients significant liver fibrosis was best predicted using the variables HBV DNA levels, alkaline phosphatase, albumin, and platelet counts with an area under ROC curve (AUC) of 0.91 for the training group and 0.85 for the validation group. Using the low cutoff probability of 4.72, significant fibrosis could be excluded with negative predictive value of 99% in the entire cohort, and liver biopsy would have been avoided in 52% of patients. The best model for predicting significant inflammation included the variables age, HBV DNA levels, AST, and albumin with an AUC of 0.93 in the training and 0.82 in the validation group. In HBeAg positive patients no factor could predict accurately stages of liver fibrosis, but the best factor for predicting significant inflammation was AST with an AUC of 0.87.
  
  
  CONCLUSIONS
  Significant hepatic fibrosis and necroinflammation can reliably be predicted using routinely checked tests and HBV DNA levels.
authors.affiliation: Digestive Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Mohamadnejad
authors.forename: Ghodrat
authors.initials: G
authors.lastname: Montazeri
authors.forename: Atoosa
authors.initials: A
authors.lastname: Fazlollahi
authors.forename: Farhad
authors.initials: F
authors.lastname: Zamani
authors.forename: Jafar
authors.initials: J
authors.lastname: Nasiri
authors.forename: Hossein
authors.initials: H
authors.lastname: Nobakht
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Forouzanfar
authors.forename: Shifteh
authors.initials: S
authors.lastname: Abedian
authors.forename: Seyed Mohamad
authors.initials: SM
authors.lastname: Tavangar
authors.forename: Ashraf
authors.initials: A
authors.lastname: Mohamadkhani
authors.forename: Farhad
authors.initials: F
authors.lastname: Ghoujeghi
authors.forename: Arezoo
authors.initials: A
authors.lastname: Estakhri
authors.forename: Negin
authors.initials: N
authors.lastname: Nouri
authors.forename: Zahra
authors.initials: Z
authors.lastname: Farzadi
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Najjari
authors.forename: Reza
authors.initials: R
authors.lastname: Malekzadeh
mesh_terms: D000328:Adult; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D006513:Hepatitis B e Antigens / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000150:complications*; D006801:Humans; D007249:Inflammation / Q000175:diagnosis; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008297:Male; D010976:Platelet Count; D012372:ROC Curve; D012709:Serum Albumin / Q000032:analysis
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D012709:Serum Albumin; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase