title: Noninvasive assessment of liver damage in chronic hepatitis B.
abstract: OBJECTIVE
  To evaluate the efficacy of the aspartate aminotransferase/platelet ratio index (APRI) and neutrophil-lymphocyte (N/L) ratio to predict liver damage in chronic hepatitis B (CHB).
  
  
  METHODS
  We analyzed 89 patients diagnosed with CHB by percutaneous liver biopsy and 43 healthy subjects. Liver biopsy materials were stained with hematoxylin-eosin and Masson's trichrome. Patients' fibrosis scores and histological activity index (HAI) were calculated according to the Ishak scoring system. Fibrosis score was recognized as follows: F0-1 No /early-stage fibrosis, F2-6 significant fibrosis, F0-4 non-cirrhotic and F5-6 cirrhotic. Significant liver ﬁbrosis was deﬁned as an Ishak score of ≥ 2. APRI and N/L ratio calculation was made by blood test results.
  
  
  RESULTS
  The hepatitis B and control group showed no difference in N/L ratios while there was a significant difference in terms of APRI scores (P < 0.001). Multiple logistic regression analysis revealed that the only independent predictive factor for liver fibrosis in CHB was platelet count. APRI score was significantly higher in cirrhotic patients than in non-cirrhotic patients. However, this significance was not confirmed by multiple logistic regression analysis. The optimum APRI score cut-off point to identify patients with cirrhosis was 1.01 with sensitivity, specificity, positive predictive value and negative predictive value of 62% (36%-86%), 74% (62%-83%), 29% (13%-49%) and 92% (82%-97%), respectively. In addition, correlation analyses revealed that N/L ratio has a negative and significant relationship with HAI (r = -0.218, P = 0.041).
  
  
  CONCLUSIONS
  N/L ratio was negatively correlated with HAI. APRI score may be useful to exclude cirrhosis in CHB patients.
authors.affiliation: Mehmet Celikbilek, Department of Gastroenterology, Medical School, Bozok University, 66200 Yozgat, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Celikbilek
authors.forename: Serkan
authors.initials: S
authors.lastname: Dogan
authors.forename: Sebnem
authors.initials: S
authors.lastname: Gursoy
authors.forename: Gokmen
authors.initials: G
authors.lastname: Zararsız
authors.forename: Alper
authors.initials: A
authors.lastname: Yurci
authors.forename: Omer
authors.initials: O
authors.lastname: Ozbakır
authors.forename: Kadri
authors.initials: K
authors.lastname: Guven
authors.forename: Mehmet
authors.initials: M
authors.lastname: Yucesoy
keywords: Chronic hepatitis B; Fibrosis; Liver cirrhosis; Noninvasive; Serum markers
references.citation: World J Gastroenterol. 2007 Jan 28;13(4):525-31
references.pmid: 17278217
references.citation: Hepatology. 2009 Sep;50(3):661-2
references.pmid: 19714720
references.citation: Hepatology. 2000 Sep;32(3):477-81
references.pmid: 10960438
references.citation: J Hepatol. 1995 Jun;22(6):696-9
references.pmid: 7560864
references.citation: World J Hepatol. 2012 Mar 27;4(3):74-80
references.pmid: 22489259
references.citation: Gut. 2006 Apr;55(4):569-78
references.pmid: 16531536
references.citation: J Med Virol. 2012 Dec;84(12):1889-96
references.pmid: 23080492
references.citation: J Hepatol. 2009 Feb;50(2):227-42
references.pmid: 19054588
references.citation: Liver Int. 2007 Sep;27(7):969-76
references.pmid: 17696936
references.citation: BMC Gastroenterol. 2012 Feb 14;12:14
references.pmid: 22333407
references.citation: Hepat Mon. 2011 Feb;11(2):103-6
references.pmid: 22087126
references.citation: Turk J Gastroenterol. 2012 Aug;23(4):353-8
references.pmid: 22965506
references.citation: Lancet. 2010 Apr 24;375(9724):1419-20
references.pmid: 20417845
references.citation: Curr Hepat Rep. 2011 Jun;10(2):87-97
references.pmid: 21654911
references.citation: Hepatology. 2011 Jan;53(1):219-29
references.pmid: 21140473
references.citation: J Hepatol. 2010 Jan;52(1):136-44
references.pmid: 19913936
references.citation: Liver Int. 2012 Feb;32(2):297-302
references.pmid: 22097893
references.citation: Liver Int. 2006 Aug;26(6):666-72
references.pmid: 16842322
references.citation: Dig Liver Dis. 2008 Apr;40(4):267-74
references.pmid: 18055281
references.citation: Eur J Cancer. 2012 Sep;48(13):1977-87
references.pmid: 22325840
references.citation: Ann Surg. 2009 Jul;250(1):141-51
references.pmid: 19561458
references.citation: Hepatology. 2003 Aug;38(2):518-26
references.pmid: 12883497
references.citation: Hepatology. 2008 Nov;48(5):1451-9
references.pmid: 18924246