A noninvasive model to predict liver histology in HBeAg‐positive chronic hepatitis B with alanine aminotransferase ≤ 2upper limit of normal

Gao, Shuai; Li, Xin-You; Fan, Yu–Chen; Sun, Feng Kai; Han, Li; Li, Feng; Ji, Xiang‐Fen; Wang, Kai

doi:10.1111/jgh.13452

Cited by 13 publications

(14 citation statements)

References 30 publications

(63 reference statements)

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“…However, we did not find that other serum markers, such as ALT and AST, were significantly correlated with HIA. The difference between our study and other studies 8,31 may lie in the small sample size of our study. Nonetheless, the combined model exhibited a favorable performance in the test cohort (AUC, 0.911).…”

Section: Discussioncontrasting

confidence: 64%

“…4 However, prior studies have demonstrated that a significant number of patients with ALT <2 ULN may also have histologically significant HIA. [7][8][9] Thus, serum markers reveal a low accuracy for staging HIA and are susceptible to hepatic and extrahepatic conditions. 10 Magnetic resonance imaging (MRI) is a promising technique in abdominal imaging, especially in the evaluation of CLD and detection and characterization of focal lesions.…”

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confidence: 99%

“…An alanine aminotransferase (ALT) level more than two times above the upper limit of normal (ULN), as a common serum marker, is usually used to guide clinical decision‐making instead of histologically significant HIA 4 . However, prior studies have demonstrated that a significant number of patients with ALT <2 ULN may also have histologically significant HIA 7–9 . Thus, serum markers reveal a low accuracy for staging HIA and are susceptible to hepatic and extrahepatic conditions 10 .…”

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confidence: 99%

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MRI‐Based Radiomics Models Developed With Features of the Whole Liver and Right Liver Lobe: Assessment of Hepatic Inflammatory Activity in Chronic Hepatic Disease

Song

et al. 2020

Magnetic Resonance Imaging

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Background: The noninvasive assessment of hepatic inflammatory activity (HIA) is crucial for making clinical decisions and monitoring therapeutic efficacy in chronic liver disease (CLD). Purpose: To develop MRI-based radiomics models by extracting features from the whole liver and localized regions of the right liver lobe, compare the efficiency of two radiomics models, and further develop a radiomics nomogram for the assessment of HIA in CLD. Study Type: Retrospective. Population: In all, 137 consecutive patients. Field Strength/Sequence: 1.5T/T 2-weighted imaging. Assessment: All patients (nonsignificant HIA, n = 98; significant HIA, n = 39) were randomly divided into a training (n = 95) and a test cohort (n = 42). Radiomics features were extracted from the regions covering the whole liver (ROI-w) and localized regions of the right liver lobe (ROI-r). Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analyses were used to select features and develop radiomics models. A combined model fusing the valuable radiomics features with clinical-radiological predictors was developed. Finally, a radiomics nomogram derived from the combined model was developed. Statistical Tests: Synthetic minority oversampling technique algorithm, LASSO, receiver operator characteristic curve, and calibration curve analysis were performed. Results: The area under the curve (AUC), sensitivity, and specificity of the ROI-w radiomics model in assessing HIA were 0.858, 0.800, and 0.733, respectively. The ROI-r model were 0.844, 0.733, and 0.867, respectively. No differences were detected between the two radiomics models (P = 0.8329). The combined model fusing valuable ROI-w radiomics features, albumin, and periportal edema exhibited a promising performance (AUC, 0.911). The calibration curves showed good agreement between the actual observations and nomogram predictions. Data Conclusion: The MRI-based radiomics models had a powerful ability to evaluate HIA and the ROI-w radiomics model was comparable to the ROI-r model. Moreover, the radiomics nomogram could be a favorable method to individually estimate HIA in CLD.

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Section: Discussioncontrasting

confidence: 64%

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confidence: 99%

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confidence: 99%

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MRI‐Based Radiomics Models Developed With Features of the Whole Liver and Right Liver Lobe: Assessment of Hepatic Inflammatory Activity in Chronic Hepatic Disease

Song

et al. 2020

Magnetic Resonance Imaging

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“…Currently, multiple noninvasive methods based on laboratory tests have been developed as surrogates to assess liver fibrosis, such as aspartate aminotransferase–platelet index (APRI), fibrosis index based on the four factors (FIB-4), Forns’ index [ 9 ], and Hui model [ 10 ]. Gao et al [ 11 ] had reported a noninvasive model, consisting of aspartate transaminase (AST), HBsAg, platelet, and albumin, to predict significant liver histology change [necroinflammatory activity grade ( G ) ≥ 2 or fibrosis stage ( S ) ≥ 2] in HBeAg-positive CHB with ALT ≤ 2ULN. Gao’s model had an area under the receiver operating characteristic curve of 0.868, which was significantly higher than APRI and FIB-4.…”

Section: Introductionmentioning

confidence: 99%

Serum YKL-40 as a biomarker for liver fibrosis in chronic hepatitis B patients with normal and mildly elevated ALT

et al. 2018

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PurposeYKL-40 is a chitinase-like protein expressed in multiple tissues including liver and is reported as a fibrosis marker. This study aimed to determine whether YKL-40 could serve as a diagnostic marker for the assessment of liver fibrosis in chronic hepatitis B patients with normal and mildly elevated ALT.MethodsSix hundred and eighty-five patients with chronic hepatitis B infection were enrolled in this study from October 2013 to March 2016. All patients underwent liver biopsy and then staged based on Ishak histological system. Serum YKL-40 levels were measured by Human Magnetic Luminex Assays.ResultsAmong chronic hepatitis B patients with normal and mildly elevated ALT, almost more than 30% of patients have significant liver fibrosis. Serum YKL-40 levels increased significantly in parallel with the progression of fibrosis in patients with ALT less than two times the upper limit of normal range (P < 0.0001). Multivariate analysis revealed that serum YKL-40, hyaluronic acid, PLT, and AST were independently associated with significant fibrosis. We established a novel YKL-40-based fibrosis model for patients with ALT less than two times the upper limit of normal range (ULN). YKL-40 model was superior to APRI, FIB-4, Forns’ index, and Hui model for diagnosis of significant fibrosis in patients with ALT < 2ULN, with AUROCs of 0.786 [95% confidence interval (CI) 0.726–0.846] in the training group, 0.831 (95%CI 0.752–0.910) in the validation group and 0.801 (95%CI 0.753–0.849) in the entire cohort.ConclusionSerum YKL-40 is a feasible biomarker of liver fibrosis in chronic hepatitis B patients. YKL-40 model was superior to APRI, FIB-4, Forns’ index and Hui model for diagnosis of significant fibrosis in patients with normal and mildly elevated ALT.Electronic supplementary materialThe online version of this article (10.1007/s15010-018-1136-2) contains supplementary material, which is available to authorized users.

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“…Serum AST had been widely used to evaluate liver necroinflammation due to its association with mitochondrial injury ( 7 ). Serum ALB is also associated with liver necroinflammation, as its production is affected by liver injury ( 21 ). In addition, ALT is commonly used to evaluate the severity of liver necroinflammation, with increases in ALT levels indicating histopathological changes in the liver, even in patients with ALT within the normal range ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

A promising non‑invasive index for predicting liver inflammation in chronic hepatitis B patients with alanine aminotransferase ≤2 upper limit of normal

Xiao

et al. 2018

Exp Ther Med

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Inexpensive and simple non-invasive indexes for predicting liver inflammation are urgently required, but have been poorly studied in chronic hepatitis B (CHB) patients with alanine transaminase (ALT) ≤2 times the upper limit of normal (ULN). A total of 356 CHB patients with ALT ≤2 ULN who presented at Huashan Hospital (n=181) and the First Hospital of Quanzhou (n=175) were enrolled and randomly divided into an experimental assessment cohort (n=238) and validation cohort (n=118) at a ratio of 2:1. Histological analysis of liver tissue was performed to determine the pathological stage according to the Scheuer scoring system. For the experimental assessment cohort, univariate and multivariate analysis identified aspartate aminotransferase (AST) and albumin (ALB) as independent predictors of liver necroinflammation [liver necroinflammation grade (G)≥2] in patients with ALT ≤2 ULN. Therefore, a novel index, the AST-to-ALB ratio (ATAR), was proposed, which had a better diagnostic performance [area under receiver operating characteristic curve (AUC)=0.721] than that of ALB (AUC=0.632; P=0.039 vs. ATAR) and AST (AUC=0.682; P=0.082 vs. ATAR). In the validation cohort, the AUC of ATAR (0.728) to identify patients with a G≥2 was slightly greater than that of AST (0.660; P=0.149 vs. ATAR) and ALB (0.672; P=0.282 vs. ATAR). Furthermore, a similar diagnostic superiority was also demonstrated in patients with ALT ≤1 ULN. Thus, ATAR may be a promising non-invasive surrogate marker for liver necroinflammation CHB patients with ALT ≤2 ULN and thereby determine whether anti-viral treatment should be initiated.

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A noninvasive model to predict liver histology in HBeAg‐positive chronic hepatitis B with alanine aminotransferase ≤ 2upper limit of normal

Abstract: 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.

Cited by 13 publications

References 30 publications

MRI‐Based Radiomics Models Developed With Features of the Whole Liver and Right Liver Lobe: Assessment of Hepatic Inflammatory Activity in Chronic Hepatic Disease

MRI‐Based Radiomics Models Developed With Features of the Whole Liver and Right Liver Lobe: Assessment of Hepatic Inflammatory Activity in Chronic Hepatic Disease

Serum YKL-40 as a biomarker for liver fibrosis in chronic hepatitis B patients with normal and mildly elevated ALT

A promising non‑invasive index for predicting liver inflammation in chronic hepatitis B patients with alanine aminotransferase ≤2 upper limit of normal

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