Usefulness of non-invasive markers for predicting liver cirrhosis in patients with chronic hepatitis B.
OBJECTIVE
Recently, various non-invasive blood markers and indices have been studied to overcome the limitations of liver biopsy, such as its invasiveness and sampling errors. However, the majority of these studies have focused on patients with chronic hepatitis C. Accordingly, this study was performed to evaluate the significances of various non-invasive serum markers in terms of predicting the presence of liver cirrhosis in chronic hepatitis B.


METHODS
We included 125 chronic hepatitis B patients who had undergone liver biopsy. Fibrosis stage was assessed using the METAVIR scoring system (F0-F4), which defines liver cirrhosis as F4. In addition, we measured various blood markers at times of liver biopsy.


RESULTS
Thirty four of the 125 patients (27.2%) were rated as F4 by liver biopsy. Age, platelet, white blood cells, aspartate aminotransferase (AST), alanine aminotransferase, haptoglobin, apolipoprotein-A1 (Apo-A1), collagen-IV, hyaluronic acid, alpha2-macroglobulin, matrix metalloproteinase-2, and YKL-40 were significantly different between patients with chronic hepatitis and those with liver cirrhosis. However, multivariate analysis showed that only platelet, AST, haptoglobin, and Apo-A1 independently predicted the presence of liver cirrhosis. Having identified these four factors, we devised a system, which we refer to as platelet count, AST, haptoglobin, and Apo-A1 (PAHA). The area under the receiver-operating characteristics (AUROC) of PAHA indices for the presence of liver cirrhosis was 0.924 (95% confidence interval, 0.877-0.971), which was significantly greater than the AUROC of other indices of fibrosis.


CONCLUSIONS
The devised PAHA system was found to be useful for predicting the presence of liver cirrhosis in patients with chronic hepatitis B.
Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Kwang Gyun
KG
Lee
Yeon Seok
YS
Seo
Hyonggin
H
An
Soon Ho
SH
Um
Eun Suk
ES
Jung
Bora
B
Keum
Hyung Joon
HJ
Yim
Yoon Tae
YT
Jeen
Hoon Jai
HJ
Chun
Chang Duck
CD
Kim
Ho Sang
HS
Ryu
D000328:Adult; D016632:Apolipoprotein A-I / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006242:Haptoglobins / Q000032:analysis; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications* / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology / Q000821:virology; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology / Q000821:virology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
C505693:APOA1 protein, human; D016632:Apolipoprotein A-I; D015415:Biomarkers; D006242:Haptoglobins; D001219:Aspartate Aminotransferases