Comparative Analysis of Noninvasive Models to Predict Early Liver Fibrosis in Hepatitis B e Antigen-negative Chronic Hepatitis B

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http://journals.lww.com/jcge/Abstract/2011/03000/Comparative_Analysis_of_Noninva\

sive_Models_to.15.aspx

Journal of Clinical Gastroenterology:

March 2011 - Volume 45 - Issue 3 - p 278–285

doi: 10.1097/MCG.0b013e3181dd5357

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Comparative Analysis of Noninvasive Models to Predict Early Liver Fibrosis in

Hepatitis B e Antigen-negative Chronic Hepatitis B

Lee, I-Cheng MD*,†; Chan, Che-Chang MD*,‡; Huang, Yi-Hsiang MD, PhD*,‡;

Huo, Teh-Ia MD*; Chu, Chi-Jen MD*; Lai, Chiung-Ru MD§; Lee, Pui-Ching BPH*; Su,

Chien-Wei MD*,‡; Hung, Hung-Hsu MD*,†; Wu, Jaw-Ching MD‡,∥; Lin,

Han-Chieh MD*; Lee, Shou-Dong MD*

Abstract

Background: Portal or bridging fibrosis is an indication for antiviral treatment

in patients with chronic hepatitis B (CHB). An early marker predictive of liver

fibrosis in hepatitis B e antigen (HBeAg)-negative CHB patients can alert

clinicians to plan for treatment before disease progression.

Goals: To predict early and significant liver fibrosis (Ishak score ≥2) in

HBeAg-negative CHB by validating several noninvasive markers derived from CHC.

Study: One hundred seventy-seven consecutive treatment-naive HBeAg-negative CHB

patients who underwent liver biopsy were divided into a training group (n=121)

and a validation group (n=56). Factors associated with liver fibrosis were

analyzed.

Results: Multivariate analysis identified Lok's model ≥0.87, cirrhosis

discriminant score greater than 4, and positive alanine aminotransferase ratio

platelet score as independent factors associated with liver fibrosis in the

training group. The area under the receiver operating characteristic curve

revealed that Lok's model was better than cirrhosis discriminant score in

predicting liver fibrosis in both the training and the validation groups. In

patients with hepatitis B virus DNA greater than 2000 IU/mL or greater than

20,000 IU/mL, Lok's model showed equal prediction value (area under the receiver

operating characteristic curve 0.709 and 0.704, respectively). Lok's model could

also discriminate high and low hepatitis B virus DNA loads. In general, liver

biopsy can be avoided in one-third (58 of 177) of patients by Lok's model.

Conclusions: Lok's model ≥0.87 can be an early marker of liver fibrosis in

HBeAg-negative CHB patients. Lok's model has clinical applications not only for

CHC, but also for HBeAg-negative CHB.

© 2011 Lippincott & Wilkins, Inc.

[Guest guest]

http://journals.lww.com/jcge/Abstract/2011/03000/Comparative_Analysis_of_Noninva\

sive_Models_to.15.aspx

Journal of Clinical Gastroenterology:

March 2011 - Volume 45 - Issue 3 - p 278–285

doi: 10.1097/MCG.0b013e3181dd5357

LIVER, PANCREAS AND BILIARY TRACT: Original Articles

Comparative Analysis of Noninvasive Models to Predict Early Liver Fibrosis in

Hepatitis B e Antigen-negative Chronic Hepatitis B

Lee, I-Cheng MD*,†; Chan, Che-Chang MD*,‡; Huang, Yi-Hsiang MD, PhD*,‡;

Huo, Teh-Ia MD*; Chu, Chi-Jen MD*; Lai, Chiung-Ru MD§; Lee, Pui-Ching BPH*; Su,

Chien-Wei MD*,‡; Hung, Hung-Hsu MD*,†; Wu, Jaw-Ching MD‡,∥; Lin,

Han-Chieh MD*; Lee, Shou-Dong MD*

Abstract

Background: Portal or bridging fibrosis is an indication for antiviral treatment

in patients with chronic hepatitis B (CHB). An early marker predictive of liver

fibrosis in hepatitis B e antigen (HBeAg)-negative CHB patients can alert

clinicians to plan for treatment before disease progression.

Goals: To predict early and significant liver fibrosis (Ishak score ≥2) in

HBeAg-negative CHB by validating several noninvasive markers derived from CHC.

Study: One hundred seventy-seven consecutive treatment-naive HBeAg-negative CHB

patients who underwent liver biopsy were divided into a training group (n=121)

and a validation group (n=56). Factors associated with liver fibrosis were

analyzed.

Results: Multivariate analysis identified Lok's model ≥0.87, cirrhosis

discriminant score greater than 4, and positive alanine aminotransferase ratio

platelet score as independent factors associated with liver fibrosis in the

training group. The area under the receiver operating characteristic curve

revealed that Lok's model was better than cirrhosis discriminant score in

predicting liver fibrosis in both the training and the validation groups. In

patients with hepatitis B virus DNA greater than 2000 IU/mL or greater than

20,000 IU/mL, Lok's model showed equal prediction value (area under the receiver

operating characteristic curve 0.709 and 0.704, respectively). Lok's model could

also discriminate high and low hepatitis B virus DNA loads. In general, liver

biopsy can be avoided in one-third (58 of 177) of patients by Lok's model.

Conclusions: Lok's model ≥0.87 can be an early marker of liver fibrosis in

HBeAg-negative CHB patients. Lok's model has clinical applications not only for

CHC, but also for HBeAg-negative CHB.

© 2011 Lippincott & Wilkins, Inc.