aMAP Score and Its Combination With Liver Stiffness Measurement Accurately Assess Liver Fibrosis in Chronic Hepatitis B Patients

Ren, F.; Li, Guanlin; Yu, Na; Chang, Xiujuan; Arshad, Tamoore; Liu, Wen-Yue; Chen, Yan; Wong, Grace Lai–Hung; Jiang, Yiyue; Liang, Xieer; Chen, Yongpeng; Jin, Xiaozhi; Zheng, Dong; Leung, Howan; Wang, Xiaodong; Zeng, Zhen; Yip, Terry Cheuk‐Fung; Quan, Xie; Tan, Deming; You, Sylvaine; Dong, Jie; Zhao, Jun; Sanyal, Arun J.; Sun, Jun; Zheng, Ming‐Hua; Wong, Vincent Wai‐Sun; Yang, Yongping; Hou, Jinlin

doi:10.1016/j.cgh.2023.03.005

Cited by 5 publications

(5 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The results were similar to a previous study, which demonstrated that the aMAP score could be used to detect CHBrelated cirrhosis and advanced fibrosis. 13 Admittedly, the fibrosis diagnostic performance of APRI was unsatisfactory in this study, so the superiority of aMAP to APRI is of limited significance. However, aMAP still outperformed FIB-4 in cirrhosis identification by using dual cut-offs, avoiding more patients from unnecessary liver biopsies with higher diagnostic accuracy.…”

Section: Discussionmentioning

confidence: 63%

See 1 more Smart Citation

Machine‐learning model comprising five clinical indices and liver stiffness measurement can accurately identify MASLD‐related liver fibrosis

Fan,

Yu,

et al. 2023

Liver International

Self Cite

View full text Add to dashboard Cite

Background & AimsaMAP score, as a hepatocellular carcinoma risk score, is proven to be associated with the degree of chronic hepatitis B‐related liver fibrosis. We aimed to evaluate the ability of aMAP score for metabolic dysfunction‐associated steatotic liver disease (MASLD; formerly NAFLD)‐related fibrosis diagnosis and establish a machine‐learning (ML) model to improve the diagnostic performance.MethodsA total of 946 biopsy‐proved MASLD patients from China and the United States were included in the analysis. The aMAP score, demographic/clinical indices and liver stiffness measurement (LSM) were included in seven ML algorithms to build fibrosis diagnostic models in the training set (N = 703). The performance of ML models was evaluated in the external validation set (N = 125).ResultsThe AUROCs of aMAP versus fibrosis‐4 index (FIB‐4) and aspartate aminotransferase‐platelet ratio (APRI) in cirrhosis and advanced fibrosis were (0.850 vs. 0.857 [P = 0.734], 0.735 [P = 0.001]) and (0.759 vs. 0.795 [P = 0.027], 0.709 [P = 0.049]). When using dual cut‐off values, aMAP had a smaller uncertainty area and higher accuracy (26.9%, 86.6%) than FIB‐4 (37.3%, 85.0%) and APRI (59.0%, 77.3%) in cirrhosis diagnosis. The seven ML models performed satisfactorily in most cases. In the validation set, the ML model comprising LSM and 5 indices (including age, sex, platelets, albumin and total bilirubin used in aMAP calculator), built by logistic regression algorithm (called LSM‐plus model), exhibited excellent performance. In cirrhosis and advanced fibrosis detection, the LSM‐plus model had higher accuracy (96.8%, 91.2%) than LSM alone (86.4%, 67.2%) and Agile score (76.0%, 83.2%), respectively. Additionally, the LSM‐plus model also displayed high specificity (cirrhosis: 98.3%; advanced fibrosis: 92.6%) with satisfactory AUROC (0.932, 0.875, respectively) and sensitivity (88.9%, 82.4%, respectively).ConclusionsThe aMAP score is capable of diagnosing MASLD‐related fibrosis. The LSM‐plus model could accurately identify MASLD‐related cirrhosis and advanced fibrosis.

show abstract

Section: Discussionmentioning

confidence: 63%

“…11,12 It is also useful for detecting advanced fibrosis and cirrhosis in chronic hepatitis B (CHB). 13 Therefore, we hypothesized that the aMAP score could also be used as a non-invasive tool to detect MASLD-related fibrosis.…”

Section: Introductionmentioning

confidence: 99%

Machine‐learning model comprising five clinical indices and liver stiffness measurement can accurately identify MASLD‐related liver fibrosis

Fan,

Yu,

et al. 2023

Liver International

Self Cite

View full text Add to dashboard Cite

show abstract

“…An aMAP score of ≥50 indicates a medium to high risk of HCC. A recent study demonstrated that the aMAP score has substantial value in evaluating advanced liver fibrosis and cirrhosis in patients with CHB ( 21 ). Our study reveals that according to the 2017 EASL guideline, among individuals with ultra-high HBV viral load and an aMAP score of ≥50, 24.7% (18/73) of patients in both HBeAg-positive and -negative chronic infected stages do not require antiviral treatment.…”

Section: Discussionmentioning

confidence: 99%

“…FIB-4, in addition to evaluating the degree of liver fibrosis, is also useful in predicting HCC risk and even liver disease-related death (19). Kim et al retrospectively analyzed 413 cases of HBV infection during the IT phase, and stratification analysis revealed that patients with FIB-4 >1.45 had a significantly higher 5-year cumulative incidence of HCC compared to those with FIB-4 <1.45 (20). Following 'eALT-F,' the new staging method, in our study, those with HBeAg-positive chronic infection and chronic hepatitis account for 13.0% and 79.6%, respectively, and those with HBeAg-negative chronic infection and chronic hepatitis account for 0.4% and 7.0%, respectively.…”

Section: Discussionmentioning

confidence: 99%

eALT-F: A New Non-Invasive Staging Method to Identify Medium to High-Risk Patients with HCC from Ultra-High HBV Viral Load Population — China, 2010–2023

Zheng,

Wang,

Wang

et al. 2023

China CDC Weekly

View full text Add to dashboard Cite

Background The objective of this study was to examine the clinical characteristics of individuals with ultra-high hepatitis B virus (HBV) viral load and develop a novel staging method for chronic hepatitis B (CHB) that can more effectively identify patients with medium to high hepatocellular carcinoma (HCC) risk. Methods A total of 2,118 patients with HBV DNA >1×10 7 IU/mL who visited Peking University People’s Hospital between January 2010 and March 2023 were enrolled retrospectively. Clinical data from the first visit were obtained and analyzed. The traditional phases and new ‘eALT-F’ stages were compared to evaluate the risk of HCC. Results In the overall patients, more than one-third of the patients were under 30 years old. Additionally, a small proportion of older people (>60 years) also had ultra-high HBV viral load (4.3%). 9.1% and 6.7% of individuals with ultra-high HBV viral load showed FIB-4>3.25 and aMAP≥50, respectively. In the traditional stages of CHB, which are based on HBeAg and alanine aminotransferase (ALT) [the upper limit of normal (ULN) ALT level at 40 IU/L for both men and women], regardless of phase, a certain proportion of patients were at risk of developing HCC (4.1%, 6.4%, 25.0%, and 20.3%). However, in the new ‘eALT-F’ stages, which are based on HBeAg, ALT (the ULN of ALT level at 30 IU/L for men and 19 IU/L for women), and/or FIB-4 levels (>1.45), aMAP≥50 was only observed in chronic hepatitis patients with positive or negative HBeAg (6.4% and 22.1%, respectively). Conclusions The ‘eALT-F’ staging method, based on HBeAg, ALT (males: the ULN of ALT was 30 IU/L, females: 19 IU/L) and/or FIB-4 levels, was more effective in identifying medium to high-risk patients with HCC from patients with ultra-high HBV viral load than the traditional staging methods.

show abstract

“…In the cross-sectional analysis of 2053 patients, the AUROC of aMAP in diagnosing advanced fibrosis (F3-F4) and cirrhosis (F4) were 0.76 and 0.79, respectively, and comparable with those for FIB-4 and APRI. Combining aMAP with LSM (aMAP-LSM model) by calculating aMAP and LSM results before and after treatment, had good performance in diagnosing advanced fibrosis and cirrhosis after treatment with AUROC 0.84 for both advanced fibrosis and cirrhosis compared with LSM alone [64].…”

Section: Combination Of Non-invasive Tests For Fibrosis Assessmentmentioning

confidence: 99%

Non-Invasive Assessment of Liver Fibrosis in Hepatitis B Patients

Bera,

Hamdan-Perez,

Patel

2024

JCM

View full text Add to dashboard Cite

The aim of this review is to provide updated information on the clinical use of non-invasive serum and imaging-based tests for fibrosis assessment in chronic hepatitis B (CHB) virus infection. In recent years, non-invasive tests (NIT) have been increasingly used to determine eligibility for treatment. Liver biopsy is still considered the gold standard for assessing inflammatory activity and fibrosis staging, but it is an invasive procedure with inherent limitations. Simple serum markers such as APRI and FIB-4 are limited by indeterminate results but remain useful initial tests for fibrosis severity if imaging elastography is not available. Point-of-care US-based elastography techniques, such as vibration-controlled transient elastography or 2D shear wave elastography, are increasingly available and have better accuracy than simple serum tests for advanced fibrosis or cirrhosis, although stiffness cut-offs are variable based on E-antigen status and inflammatory activity. Current NITs have poor diagnostic performance for following changes in fibrosis with antiviral therapy. However, NITs may have greater clinical utility for determining prognosis in patients with CHB that have advanced disease, especially for the development of hepatocellular carcinoma and/or liver decompensation. Algorithms combining serum and imaging NITs appear promising for advanced fibrosis and prognostic risk stratification.

show abstract

aMAP Score and Its Combination With Liver Stiffness Measurement Accurately Assess Liver Fibrosis in Chronic Hepatitis B Patients

Cited by 5 publications

References 26 publications

Machine‐learning model comprising five clinical indices and liver stiffness measurement can accurately identify MASLD‐related liver fibrosis

Machine‐learning model comprising five clinical indices and liver stiffness measurement can accurately identify MASLD‐related liver fibrosis

eALT-F: A New Non-Invasive Staging Method to Identify Medium to High-Risk Patients with HCC from Ultra-High HBV Viral Load Population — China, 2010–2023

Non-Invasive Assessment of Liver Fibrosis in Hepatitis B Patients

Contact Info

Product

Resources

About