title: HBV DNA level could predict significant liver fibrosis in HBeAg negative chronic hepatitis B patients with biopsy indication.
abstract: BACKGROUND
  Non-invasive models and methods to substitute liver biopsy in chronic hepatitis B (CHB) patients were investigated but their roles as predictors of significant liver histology for diagnosis of HBeAg-negative CHB patients who had indication for liver biopsy according to The American Association for the Study of Liver Diseases (AASLD) and The Asian Pacific Association for the Study of the Liver (APASL) guidelines are still unknown. This study was designed to identify predictors of significant liver necroinflammation as defined by a Histology Activity Index of necroinflammatory score ≥ 4 or Metavir necroinflammatory activity score ≥ 2 and significant liver fibrosis as defined by a Metavir fibrosis score ≥ 2 in HBeAg-negative CHB patients that had a hepatitis B virus (HBV) DNA level ≥ 2,000 IU/ml and age ≥ 40 years or elevated alanine aminotransferase level between 1-2 times the upper limit of normal.
  
  
  METHODS
  Twenty-two patients were prospectively included and performed liver biopsies. Clinical and laboratory parameters including age, gender, underlying disease, family history of cirrhosis or hepatocellular carcinoma, body mass index (BMI), HBV DNA level, HBsAg level, liver function test, complete blood count, aspartate aminotransferase-to-platelet ratio index and transient elastography were collected and analyzed with liver histology profiles.
  
  
  RESULTS
  Five patients (23%) had significant liver inflammation and 7 patients (32%) had significant liver fibrosis. Factors associated with significant liver inflammation were a lower BMI and higher alkaline phosphatase level while a factor associated with significant liver fibrosis was lower age. On multivariate analysis, only HBV DNA level > 5.5 log IU/ml could predict significant liver fibrosis (odds ratio 28.012, 95% CI, 1.631-481.240, p = 0.022) and its sensitivity, specificity, positive predictive value and negative predictive value were 71.4%, 93.3%, 83.3% and 87.5% respectively.
  
  
  CONCLUSIONS
  An HBV DNA level of > 5.5 log IU/ml was able to predict significant liver fibrosis for treatment of HBeAg-negative CHB patients that had indication for liver biopsy as recommended by AASLD and APASL guidelines.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand. goodycherry@hotmail.com.
authors.forename: Surat
authors.initials: S
authors.lastname: Praneenararat
authors.affiliation: Division of Gastroenterology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand. naichaya@gmail.com.
authors.forename: Naichaya
authors.initials: N
authors.lastname: Chamroonkul
authors.affiliation: Division of Gastroenterology, Department of Medicine, Prince of Songkla University, Songkhla, Thailand. pim072@hotmail.com.
authors.forename: Pimsiri
authors.initials: P
authors.lastname: Sripongpun
authors.affiliation: Division of Pathology, Department of Pathology, Prince of Songkla University, Songkhla, Thailand. Samornmas@bumrungraddoctor.com.
authors.forename: Samornmas
authors.initials: S
authors.lastname: Kanngurn
authors.affiliation: Division of Immunology, Prince of Songkla University, Songkhla, Thailand. roongrueng.j@gmail.com.
authors.forename: Roongrueng
authors.initials: R
authors.lastname: Jarumanokul
authors.affiliation: NKC Institute of Gastroenterology and Hepatology, Prince of Songkla University, Songkhla, Thailand. teerha.p@psu.ac.th.
authors.forename: Teerha
authors.initials: T
authors.lastname: Piratvisuth
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001706:Biopsy; D003430:Cross-Sectional Studies; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D005355:Fibrosis / Q000175:diagnosis; D006513:Hepatitis B e Antigens / Q000097:blood; D006515:Hepatitis B virus / Q000235:genetics*; D019694:Hepatitis B, Chronic / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D004279:DNA, Viral; D006513:Hepatitis B e Antigens