Assessment of hepatic fibrosis and necroinflammation among inactive HBsAg carriers in Egypt

Fateen, Amr Abdelkader; Shahin, Rasha Y; Farres, Mohamed Nazmy; Eldeeb, Mai; Amer, Hanan

doi:10.1016/s1665-2681(19)31459-0

Cited by 8 publications

(12 citation statements)

References 23 publications

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“…25 Data of Egyptian inactive carriers had been published recently; in them, 20% of patients had fibrosis score ≥ 2 in liver biopsy. 26 Oliveri et al reported that in chronic HBV carriers, including patients with HBV-DNA > 2000 IU/mL and elevated ALT value, HBV-DNA and ALT were factors associated with fibrosis development; metabolic factors did not achieve statistically significance in multivariate analysis; 18 but 68 patients were inactive HBV carriers and those with dysmetabolic profile had LSM higher than patients without (6.9 kPa vs 4.3 kPa, P < 0.001). In a recent study published by Wong et al with more than 1000 CHB patients, 32% had possible cirrhosis (defined as FibroScan > 8.4 kPa); male gender (OR 1.8), age > 40 years (OR 1.8), BMI > 25 Kg/m 2 (OR 1.4), albumin < 40 g/L (OR 4.2), elevated ALT (OR 2.8) and alkaline phosphatase (OR 2.4) and MS (OR 1.6) were associated with possible cirrhosis in multivariate logistic regression; OR 1.1 was reported for HBV-DNA > 2 log copies/mL, without statistically significance (P = 0.65), despite mean HBV-DNA was 5.0 log copies/mL.…”

Section: Discussionmentioning

confidence: 99%

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Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers

Mena

Pedreira

Castro

et al. 2013

J of Gastro and Hepatol

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Section: Discussionmentioning

confidence: 99%

“…A study in India reported that among inactive HBV carriers, 21% had histologically active liver disease, and 13.8% of patients had significant hepatic fibrosis . Data of Egyptian inactive carriers had been published recently; in them, 20% of patients had fibrosis score ≥ 2 in liver biopsy …”

Section: Discussionmentioning

confidence: 99%

Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers

Mena

Pedreira

Castro

et al. 2013

J of Gastro and Hepatol

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“…The grading of inflammation and staging of fibrosis were based on the Knodell histological active index (HAI), which ranges from 0 to 18, and the Ishak fibrosis score, which ranges from 0 to 6, respectively. Liver necroinflammation was defined as an HAI ≥4, and severe liver fibrosis was defined as an Ishak score ≥3 …”

Section: Methodsmentioning

confidence: 99%

“…Liver necroinflammation was defined as an HAI ≥4, [16][17][18] and severe liver fibrosis was defined as an Ishak score ≥3. 19…”

Section: Patientsmentioning

confidence: 99%

Evaluation of a logistic regression model for predicting liver necroinflammation in hepatitis B e antigen‐negative chronic hepatitis B patients with normal and minimally increased alanine aminotransferase levels

Xie

et al. 2019

Journal of Viral Hepatitis

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Liver necroinflammation is the indicator for treating patients with chronic hepatitis B (CHB) infection. However, there is no suitable non‐invasive index for diagnosing liver necroinflammation. This study aimed to create a non‐invasive index to predict liver necroinflammation in patients who lack clear‐cut clinical inflammation parameters. Patients who were hepatitis B e antigen (HBeAg)‐negative and underwent liver histological diagnosis, had a normal or minimally increased alanine aminotransferase (ALT) level were enrolled. Liver necroinflammation was defined as histological active index ≥4. A logistic regression model (LRM) was established based on the parameters independently associated with liver necroinflammation. Of all 550 patients, 36.73% had necroinflammation. In patients with an abnormal ALT level, the rate of necroinflammation was 52.49%. The area under the curve (AUC) of the ALT level for predicting necroinflammation was 0.655 (95% confidence interval [CI], 0.609‐0.702), and that of the HBV DNA level ≥2000 IU/mL combined with an abnormal ALT level was 0.618. By using the LRM, the AUC improved to 0.769 (95% CI, 0.723‐0.815) with a Youden index of 0.519 and diagnostic accuracy of 75.3%. The cutoff value ≥0.7 in the LRM had a specificity of 97.4% and positive predictive value of 85.0% for predicting necroinflammation. By using the cutoff value <0.15 in the LRM, the presence of necroinflammation could be excluded with a negative predictive value of 90.8%. This study indicated that the LRM can be used to effectively diagnose liver necroinflammation in HBeAg‐negative patients with CHB who have normal or minimally elevated ALT levels.

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“…was assessed. On liver histology, liver fibrosis score (stage) ≤ 2, and liver necro-inflammation score (grade) ≤ 4 were considered as cutoff values to show mild liver damage (11). The liver histology assessment was performed for patients with clinical and laboratory evidence of progressive liver disease, while it was performed optionally for those without such evidence.…”

Section: Methodsmentioning

confidence: 99%

How Can We Make Decision for Patients With Chronic Hepatitis B According to Hepatitis B Virus (HBV) DNA Level?

2014

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Background:HBeAg negative hepatitis B infection exerts both inactive carrier state and chronic active hepatitis, which are sometimes difficult to differentiate. Serial hepatitis B virus (HBV) DNA quantification, alanine transaminase (ALT) measurement, and liver histology assessment can help to differentiate these forms of hepatitis B infection.Objectives:We aimed to clarify the clinical and laboratory characteristics of HBeAg negative hepatitis B patients.Patients and Methods:Patients with hepatitis B, referred to Tehran Blood Transfusion Hepatitis Clinic from 2011 to 2013, were included and followed for one year. Laboratory assessments including liver function tests, HBV DNA quantification, and liver biopsy (for some cases) were performed.Results:Two hundred forty-three HBeAg negative hepatitis B patients were stratified into three groups based on to their HBV DNA level including group 1 (G1) with HBV DNA level < 2000 IU/mL, group 2 (G2) with HBV DNA level 2000-20000 IU/mL, and group 3 (G3) with HBV DNA level > 20000 IU/mL. The G2 had more similarity to G1 than G3 regarding their clinical characteristics.Conclusions:It is concluded that most HBeAg negative hepatitis B patients with serum HBV DNA level of 2000-20000 IU/mL, persistent normal ALT concentration, and no or mild liver damage on biopsy can be clinically managed as HBV inactive carriers.

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Assessment of hepatic fibrosis and necroinflammation among inactive HBsAg carriers in Egypt

Cited by 8 publications

References 23 publications

Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers

Metabolic syndrome association with fibrosis development in chronic hepatitis B virus inactive carriers

Evaluation of a logistic regression model for predicting liver necroinflammation in hepatitis B e antigen‐negative chronic hepatitis B patients with normal and minimally increased alanine aminotransferase levels

How Can We Make Decision for Patients With Chronic Hepatitis B According to Hepatitis B Virus (HBV) DNA Level?

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