title: A new model using routinely available clinical parameters to predict significant liver fibrosis in chronic hepatitis B.
abstract: OBJECTIVE
  We developed a predictive model for significant fibrosis in chronic hepatitis B (CHB) based on routinely available clinical parameters.
  
  
  METHODS
  237 treatment-naïve CHB patients [58.4% hepatitis B e antigen (HBeAg)-positive] who had undergone liver biopsy were randomly divided into two cohorts: training group (n = 108) and validation group (n = 129). Liver histology was assessed for fibrosis. All common demographics, viral serology, viral load and liver biochemistry were analyzed.
  
  
  RESULTS
  Based on 12 available clinical parameters (age, sex, HBeAg status, HBV DNA, platelet, albumin, bilirubin, ALT, AST, ALP, GGT and AFP), a model to predict significant liver fibrosis (Ishak fibrosis score ≥3) was derived using the five best parameters (age, ALP, AST, AFP and platelet). Using the formula log(index+1) = 0.025+0.0031(age)+0.1483 log(ALP)+0.004 log(AST)+0.0908 log(AFP+1)-0.028 log(platelet), the PAPAS (Platelet/Age/Phosphatase/AFP/AST) index predicts significant fibrosis with an area under the receiving operating characteristics (AUROC) curve of 0.776 [0.797 for patients with ALT <2×upper limit of normal (ULN)] The negative predictive value to exclude significant fibrosis was 88.4%. This predictive power is superior to other non-invasive models using common parameters, including the AST/platelet/GGT/AFP (APGA) index, AST/platelet ratio index (APRI), and the FIB-4 index (AUROC of 0.757, 0.708 and 0.723 respectively). Using the PAPAS index, 67.5% of liver biopsies for patients being considered for treatment with ALT <2×ULN could be avoided.
  
  
  CONCLUSIONS
  The PAPAS index can predict and exclude significant fibrosis, and may reduce the need for liver biopsy in CHB patients.
authors.affiliation: Department of Medicine, the University of Hong Kong, Queen Mary Hospital, Hong Kong.
authors.forename: Wai-Kay
authors.initials: WK
authors.lastname: Seto
authors.forename: Chun-Fan
authors.initials: CF
authors.lastname: Lee
authors.forename: Ching-Lung
authors.initials: CL
authors.lastname: Lai
authors.forename: Philip P C
authors.initials: PP
authors.lastname: Ip
authors.forename: Daniel Yee-Tak
authors.initials: DY
authors.lastname: Fong
authors.forename: James
authors.initials: J
authors.lastname: Fung
authors.forename: Danny Ka-Ho
authors.initials: DK
authors.lastname: Wong
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
mesh_terms: D000293:Adolescent; D000328:Adult; D019540:Area Under Curve; D015331:Cohort Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000175:diagnosis*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D011237:Predictive Value of Tests; D012372:ROC Curve; D015203:Reproducibility of Results; D055815:Young Adult