title: The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa.
abstract: Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa.
  
  
  
  Using liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets).
  
  
  
  Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4.
  
  
  
  The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.
authors.affiliation: Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
authors.forename: Maud
authors.initials: M
authors.lastname: Lemoine
authors.affiliation: The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia Emerging Disease Epidemilogy Unit, Institut Pasteur, Paris, France.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Shimakawa
authors.affiliation: Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Shevanthi
authors.initials: S
authors.lastname: Nayagam
authors.affiliation: Department of Histopathology, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Khalil
authors.affiliation: Department of Histopathology, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
authors.forename: Penda
authors.initials: P
authors.lastname: Suso
authors.affiliation: Centre for Pathology, Imperial College London, London, UK.
authors.forename: Jo
authors.initials: J
authors.lastname: Lloyd
authors.affiliation: Centre for Pathology, Imperial College London, London, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Goldin
authors.affiliation: The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
authors.forename: Harr-Freeya
authors.initials: HF
authors.lastname: Njai
authors.affiliation: The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
authors.forename: Gibril
authors.initials: G
authors.lastname: Ndow
authors.affiliation: Ministry of Health and Social Welfare, Banjul, The Gambia.
authors.forename: Makie
authors.initials: M
authors.lastname: Taal
authors.affiliation: Department of infectious disease, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Graham
authors.initials: G
authors.lastname: Cooke
authors.affiliation: The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
authors.forename: Umberto
authors.initials: U
authors.lastname: D'Alessandro
authors.affiliation: Emerging Disease Epidemilogy Unit, Institut Pasteur, Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Vray
authors.affiliation: Department of Hepatology and Gastroenterology, Principal Hospital, Dakar, Senegal.
authors.forename: Papa Saliou
authors.initials: PS
authors.lastname: Mbaye
authors.affiliation: The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
authors.forename: Ramou
authors.initials: R
authors.lastname: Njie
authors.affiliation: Université Paris Descartes, APHP, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Paris, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Mallet
authors.affiliation: Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Thursz
mesh_terms: D000328:Adult; D000354:Africa, Western / Q000453:epidemiology; D019540:Area Under Curve; D015415:Biomarkers / Q000032:analysis / Q000097:blood; D001706:Biopsy; D061827:Dimensional Measurement Accuracy; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D010976:Platelet Count / Q000379:methods*; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D005723:gamma-Glutamyltransferase / Q000032:analysis / Q000097:blood
chemical_list: D015415:Biomarkers; D005723:gamma-Glutamyltransferase
keywords: FIBROSIS; HEPATITIS B