title: Correlation between clinical indication for treatment and liver histology in HBeAg-negative chronic hepatitis B: a novel role of alpha-fetoprotein.
abstract: BACKGROUND
  It is unclear whether clinical indication for antiviral treatment is in agreement with histological indication in HBeAg-negative chronic hepatitis B (CHB). This study aimed to clarify this relationship and identify factors associated with liver histology.
  
  
  METHODS
  We investigated 152 consecutive, treatment-naïve, HBeAg-negative CHB patients who had undergone liver biopsies at a tertiary medical centre in Taiwan. Clinical indications for treatment included a serum alanine aminotransferase level more than twice the upper limit of normal and an hepatitis B virus DNA level > 2000 IU/ml. Factors associated with the histological indication (Ishak's grade > or = 7 and/or stage > or = 2) were analysed.
  
  
  RESULTS
  The association between the clinical and the histological indications was significant (P=0.011). However, the agreement was poor (kappa value=0.197). In patients satisfying the clinical indication, age > 52 years [odds ratio (OR)=2.669, P=0.042], serum alpha-fetoprotein (AFP) level > 7 ng/ml (OR=7.070, P<0.001) and platelet count < 130 x 10(9)/L (OR=11.720, P=0.025) were identified to be independent factors associated with histological indication. In patients who did not satisfy the clinical indication, multivariate analysis revealed that only an AFP level > 7 ng/ml (OR=10.345, P=0.021) was independently associated with histological indication. Combining the clinical indication and/or AFP level > 7 ng/ml to predict liver histology, the sensitivity and the negative predictive value could improve from 86 to 94.4% and 66.7 to 81% respectively.
  
  
  CONCLUSIONS
  AFP level is associated with liver histology in HBeAg-negative CHB. Serum AFP level can serve as a surrogate indicator to identify patients who need antiviral treatment.
authors.affiliation: Department of Medicine, Division of Gastroenterology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: I-Cheng
authors.initials: IC
authors.lastname: Lee
authors.forename: Yi-Hsiang
authors.initials: YH
authors.lastname: Huang
authors.forename: Che-Chang
authors.initials: CC
authors.lastname: Chan
authors.forename: Teh-Ia
authors.initials: TI
authors.lastname: Huo
authors.forename: Chi-Jen
authors.initials: CJ
authors.lastname: Chu
authors.forename: Chiung-Ru
authors.initials: CR
authors.lastname: Lai
authors.forename: Pui-Ching
authors.initials: PC
authors.lastname: Lee
authors.forename: Chien-Wei
authors.initials: CW
authors.lastname: Su
authors.forename: Hung-Hsu
authors.initials: HH
authors.lastname: Hung
authors.forename: Jaw-Ching
authors.initials: JC
authors.lastname: Wu
authors.forename: Han-Chieh
authors.initials: HC
authors.lastname: Lin
authors.forename: Shou-Dong
authors.initials: SD
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D001706:Biopsy; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000473:pathology*; D006652:Histological Techniques; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D013624:Taiwan; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D015415:Biomarkers; D004279:DNA, Viral; D006513:Hepatitis B e Antigens; D000509:alpha-Fetoproteins; D000410:Alanine Transaminase