A novel predictive model using routinely clinical parameters to predict liver fibrosis in patients with chronic hepatitis B
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Jian Wang1, Xiaomin Yan2, Yue Yang1, Haiyan Chang1, Bei Jia2, Xiang-An Zhao3, Guangmei Chen4, Juan Xia2, Yong Liu5, Yuxin Chen5, Guiyang Wang2, Li Wang2, Zhaoping Zhang2, Weimao Ding6, Rui Huang2 and Chao Wu1,2
1Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China
2Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
3Department of Infectious Diseases, Nanjing Drum Tower Hospital, Clinical College of Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
4Department of Infectious Diseases, Affiliated Hospital of Nanjing, University of Traditional Chinese Medicine, Nanjing, Jiangsu, China
5Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, Jiangsu, China
6Department of Hepatology, Huai’an No. 4 People’s Hospital, Huai’an, Jiangsu, China
Chao Wu, email: email@example.com
Rui Huang, email: firstname.lastname@example.org
Keywords: chronic hepatitis B, liver biopsy, liver fibrosis, serum biomarkers, non-invasive fibrosis model
Received: June 01, 2017 Accepted: June 28, 2017 Published: July 22, 2017
Objectives: Noninvasive models have been established for the assessment of liver fibrosis in patients with chronic hepatitis B(CHB). However, the predictive performance of these established models remains inconclusive. We aimed to develop a novel predictive model for liver fibrosis in CHB based on routinely clinical parameters.
Results: Platelets(PLT), the standard deviation of red blood cell distribution width(RDW-SD), alkaline phosphatase(ALP) and globulin were independent predictors of significant fibrosis by multivariable analysis. Based on these parameters, a new predictive model namely APRG(ALP/PLT/RDW-SD/globulin) was proposed. The areas under the receiver-operating characteristic curves(AUROCs) of APRG index in predicting significant fibrosis(≥F2), advanced fibrosis(≥F3) and liver cirrhosis(≥F4) were 0.757(95%CI 0.699 to 0.816), 0.763(95%CI 0.711 to 0.816) and 0.781(95%CI 0.728 to 0.835), respectively. The AUROCs of the APRG were significantly higher than that of aspartate transaminase(AST) to PLT ratio index(APRI), RDW to PLT ratio(RPR) and AST to alanine aminotransferase ratio(AAR) to predict significant fibrosis, advanced fibrosis and cirrhosis. The AUROCs of the APRG were also significantly higher than fibrosis-4 score (FIB-4) (0.723, 95%CI 0.663 to 0.783) for cirrhosis(P=0.034) and better than gamma-glutamyl transpeptidase(GGT) to PLT ratio(GPR) (0.657, 95%CI 0.590 to 0.724) for significant fibrosis(P=0.001).
Materials and Methods: 308 CHB patients who underwent liver biopsy were enrolled. The diagnostic values of the APRG for liver fibrosis with other noninvasive models were compared.
Conclusions: The APRG has a better diagnostic value than conventionally predictive models to assess liver fibrosis in CHB patients. The application of APRG may reduce the need for liver biopsy in CHB patients in clinical practice.
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