The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa

Abstract

BackgroundSimple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa.MethodsUsing liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets).ResultsOf 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4.ConclusionsThe GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.

The γ-glutamyl transpeptidase to platelet ratio (GPR) in HBV patients: just adding up?

“…However, in the present study, a somewhat better performance was observed for APRI and FIB-4 than that reported in the cohorts from Gambia and Senegal 1. Precise and inexpensive biomarkers of disease severity are highly wanted for effective public policy decision-making, particularly in resource-limited settings.…”

“…We read with interest the article by Lemoine et al evaluating routine tests as non-invasive markers of fibrosis in patients with chronic hepatitis B (CHB) 1. The γ-glutamyl transpeptidase to platelet ratio (GPR) has been proposed as a new fibrosis test, allegedly more accurate than classical biomarkers like the Aspartate Aminotransferase to Platelet Ratio Index (APRI) and FIB-4 in African cohorts.…”

The hepatitis C cascade of care in people who inject drugs in Dar es Salaam, Tanzania

“…These tests were used to calculate APRI (AST (IU/L)/its upper limit of normal (ULN)/platelet count (10 9 /L) × 100), Fib‐4 (age (years) × AST (IU/L)/(platelet count [10 9 /L] x √ALT [IU/L]) and GPR (GGT (IU/L)/its upper limit of normal (ULN)/platelet count (10 9 /L × 100) as markers of liver fibrosis. Cut‐off values were determined, as previously recommended 4, 16, 17…”

Natural history of chronic HBV infection in West Africa: a longitudinal population-based study from The Gambia

“…These cut-offs were determined by our validation study in The Gambia, where the sensitivity of Fibroscan to predict ≥F2 was 81% and the specificity was 81% 25. The EASL criteria for antiviral therapy are (i) viral load ≥2000 IU/mL and significant fibrosis, or (ii) viral load ≥2000 IU/mL and moderate/severe active necroinflammation (≥A2 by Metavir activity grade), or (iii) viral load ≥20 000 IU/mL and ALT ≥80 IU/L, or (iv) detectable viral load and cirrhosis 10.…”