title: A noninvasive model to predict liver histology in HBeAg-positive chronic hepatitis B with alanine aminotransferase ≤ 2upper limit of normal.
abstract: OBJECTIVE
  Liver biopsy remains the gold standard to evaluate liver histology. However, it has several limitations. This study aims to construct a noninvasive model to predict liver histology for commencing antiviral therapy in HBeAg-positive chronic hepatitis B (CHB) with aminotransferase (ALT) ≤ 2 upper limit of normal (ULN).
  
  
  METHODS
  Two hundred and ninety-eight patients with HBeAg-positive CHB, ALT ≤ 2ULN and HBV-DNA ≥20 000 IU/ml were enrolled and randomly divided into a training group and a validation group. A noninvasive model was constructed in the training group to predict significant liver histological change [necroinflammatory activity grade (G) ≥ 2 or fibrosis stage (S) ≥ 2] and then validated in the validation group.
  
  
  RESULTS
  Aspartate aminotransferase, HBsAg, platelet, and albumin were identified as independent predictors. A model was constructed by them. It had an area under the receiver operating characteristic curve of 0.875 in the training group, 0.858 in the validation group and 0.868 in the entire cohort. Using a cut-off point of -0.96, it showed 93% sensitivity, 90% negative predictive value (NPV) in the training group and 95% sensitivity, 94% NPV in the validation group. Using a cut-off point of 0.96, it showed 95% specificity, 91% positive predictive value (PPV) in the training group and 89% specificity, 80% PPV in the validation group.
  
  
  CONCLUSIONS
  This study constructed a noninvasive model to predict liver histology in HBeAg-positive CHB with ALT ≤ 2ULN, which might reduce the clinical need for liver biopsy.
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Shuai
authors.initials: S
authors.lastname: Gao
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Xin-You
authors.initials: XY
authors.lastname: Li
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.|Institute of Hepatology, Shandong University, Jinan, Shandong, China.
authors.forename: Yu-Chen
authors.initials: YC
authors.lastname: Fan
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Feng-Kai
authors.initials: FK
authors.lastname: Sun
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.|Institute of Hepatology, Shandong University, Jinan, Shandong, China.
authors.forename: Li-Yan
authors.initials: LY
authors.lastname: Han
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.
authors.forename: Xiang-Fen
authors.initials: XF
authors.lastname: Ji
authors.affiliation: Department of Hepatology, Qilu Hospital of Shandong University, Jinan, Shandong, China.|Institute of Hepatology, Shandong University, Jinan, Shandong, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Wang
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000998:Antiviral Agents / Q000008:administration & dosage; D015415:Biomarkers / Q000097:blood; D005260:Female; D006513:Hepatitis B e Antigens / Q000097:blood*; D019694:Hepatitis B, Chronic / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D006801:Humans; D008099:Liver / Q000473:pathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D006513:Hepatitis B e Antigens; D000410:Alanine Transaminase
keywords: chronic hepatitis B; liver biopsy; liver histology; noninvasive model