title: Comparison of noninvasive models of fibrosis in chronic hepatitis B.
abstract: OBJECTIVE
  Liver fibrosis influences treatment and surveillance strategies in chronic hepatitis B (CHB). This multicenter study aimed to examine the accuracy of serum fibrosis models in CHB patients including those with low alanine aminotransferase (ALT) levels and serially in those undergoing treatment.
  
  
  METHODS
  We examined noninvasive fibrosis models [Hepascore, Fibrotest, APRI, hepatitis e antigen (HBeAg)-positive and -negative models] in 179 CHB patients who underwent liver biopsy and fibrosis assessment by METAVIR and image morphometry. Serial Hepascore measurements were assessed in 40 subjects for up to 8.7 years.
  
  
  RESULTS
  Hepascore was more accurate than Fibrotest [area under the curve (AUC) 0.83 vs. 0.72, P = 0.05] and HBeAg-positive model (AUC 0.83 vs. 72, P = 0.03) for significant fibrosis but was not significantly different to APRI or HBeAg-negative scores. Fibrosis area assessed by morphometry was correlated with Hepascore (r = 0.603, P < 0.001), Fibrotest (r = 0.392, P = 0.03), and HBeAg-positive (r = 0.492, P = 0.001) scores only. Among 73 patients with an ALT <60 IU/L, noninvasive models were useful to predict fibrosis (PPV 80-90%) or exclude significant fibrosis (NPV 79-100%). Hepascore increased significantly among patients monitored without treatment and reduced among patients undergoing therapy (0.05/year ± 0.03 vs. -0.04/year ± 0.02, P = 0.007).
  
  
  CONCLUSIONS
  Serum fibrosis models are predictive of fibrosis in CHB and assist in identifying subjects with low-normal ALT levels for treatment.
authors: Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.
authors: S C
authors: SC
authors: Raftopoulos
authors: Storr Liver Unit, Westmead Millenium Institute, Westmead Hospital, University of Sydney, Sydney, Australia.
authors: J
authors: J
authors: George
authors: Service d'Hépato-Gastroentérologie, Hôpital Saint Joseph, Marseille, France.
authors: M
authors: M
authors: Bourliere
authors: Department of Clinical Microbiology, PathWest Laboratory Medicine, Perth, Australia.
authors: E
authors: E
authors: Rossi
authors: Department of Clinical Microbiology, PathWest Laboratory Medicine, Perth, Australia.
authors: W B
authors: WB
authors: de Boer
authors: Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.|School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, 6009, Australia.
authors: G P
authors: GP
authors: Jeffrey
authors: Department of Statistics, Notre Dame University, Fremantle, Australia.
authors: M
authors: M
authors: Bulsara
authors: Department of Clinical Microbiology, PathWest Laboratory Medicine, Perth, Australia.
authors: D J
authors: DJ
authors: Speers
authors: Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia.|School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, 6009, Australia.
authors: G
authors: G
authors: MacQuillan
authors: School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, 6009, Australia.
authors: H L I
authors: HL
authors: Ching
authors: Department of Gastroenterology, Royal Perth Hospital, Perth, Australia.
authors: N
authors: N
authors: Kontorinis
authors: Department of Gastroenterology, Royal Perth Hospital, Perth, Australia.
authors: W
authors: W
authors: Cheng
authors: Department of Clinical Microbiology, PathWest Laboratory Medicine, Perth, Australia.
authors: J
authors: J
authors: Flexman
authors: Department of Clinical Microbiology, PathWest Laboratory Medicine, Perth, Australia.
authors: S
authors: S
authors: Fermoyle
authors: Center for Microscopy, Characterisation and Analysis, University of Western Australia, Perth, Australia.
authors: P
authors: P
authors: Rigby
authors: Center for Microscopy, Characterisation and Analysis, University of Western Australia, Perth, Australia.
authors: L
authors: L
authors: Walsh
authors: Department of Anatomical Pathology, Westmead Hospital, University of Sydney, Sydney, Australia.
authors: D
authors: D
authors: McLeod
authors: Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia. leon.adams@uwa.edu.au.|School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, 6009, Australia. leon.adams@uwa.edu.au.
authors: L A
authors: LA
authors: Adams