title: Establishment and validation of a simple noninvasive model to predict significant liver fibrosis in patients with chronic hepatitis B.
abstract: BACKGROUND
  There have been still few valuable noninvasive models that can be used as indirect markers of liver fibrosis in chronic hepatitis B (CHB) infection.
  
  
  METHODS
  In 374 patients with chronic hepatitis B virus infection, the correlation between the conventional parameters and significant fibrosis confirmed by liver biopsy was assessed using univariate analysis and logistic regression. A model was established and assessed by the receiver operating characteristic (ROC) curves. Then it was validated in 108 prospectively enrolled patients. A part of the patients were followed up with cirrhosis as the end point, using survival analysis to assess the prognostic value of the model.
  
  
  RESULTS
  A model named AIAG was constructed consisting of age, international normalized ratio, albumin, and gamma-glutamyltransferase which could discriminate between CHB patients with and without significant fibrosis. The area under ROC curves was 0.842 (95% CI, 0.795-0.888) for the training group (n = 250) and 0.806 (95% CI, 0.730-0.882) for the validation group (n = 124). In the training group, using a cut-off score of <0.32, the presence of significant fibrosis could be excluded with high accuracy (90% negative predictive value); similarly, applying a cut-off score of >0.72, the presence of significant fibrosis could be correctly identified with high accuracy (93% positive predictive value). Similar results have been shown in the internal and external validation groups. In the follow-up study, we found that the AIAG score may have good prognostic values to predict the progression of clinically overt cirrhosis in CHB patients.
  
  
  CONCLUSIONS
  AIAG, a simple marker panel consisting of conventional parameters, could easily predict significant fibrosis with a high degree of accuracy.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
authors.forename: Sheng-di
authors.initials: SD
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
authors.forename: Yan-Jun
authors.initials: YJ
authors.lastname: Ni
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Liu
authors.affiliation: Department of Gastroenterology, Renji Hospital, Shanghai, People's Republic of China.
authors.forename: Hai
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Gastroenterology, The First People's Hospital, Shanghai Jiaotong University, Shanghai, People's Republic of China.
authors.forename: Lun-Gen
authors.initials: LG
authors.lastname: Lu
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, Zhongshan Hospital, Fudan University, Shanghai, 200032, People's Republic of China. wang.jiyao@zs-hospital.sh.cn.
authors.forename: Ji-Yao
authors.initials: JY
authors.lastname: Wang
keywords: Chronic HBV infection; Hepatitis B virus; Liver fibrosis; Noninvasive model