The gamma‐glutamyl transpeptidase‐to‐platelet ratio predicts liver fibrosis and cirrhosis in HBeAg‐positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China

Abstract

The gamma-glutamyl transpeptidase-to-platelet ratio (GPR) is a new serum diagnostic model, which is reported to be more accurate than aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for the diagnosis of significant fibrosis and cirrhosis in chronic HBV infection (CHBVI) patients in West Africa. To evaluate the performance of the GPR model for the diagnosis of liver fibrosis and cirrhosis in HBeAg-positive CHBVI patients with high HBV DNA (≥5 log copies/mL) and normal or mildly elevated alanine transaminase (ALT) (≤2 times upper limit of normal (ULN)) in China. A total of 1521 consecutive CHBVI patients who underwent liver biopsies and routine laboratory tests were retrospectively screened. Of these patients, 401 treatment naïve HBeAg-positive patients with HBV DNA≥5 log copies/mL and ALT≤2 ULN were included. The METAVIR scoring system was adopted as the pathological diagnosis standard of liver fibrosis. Using liver histology as a gold standard, the performances of GPR, APRI, and Fib-4 for the diagnosis of liver fibrosis and cirrhosis were evaluated and compared by receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of 401 patients, 121 (30.2%), 49 (12.2%) and 17 (4.2%) were classified as having significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4), respectively. After estimating the AUROC to predict significant fibrosis, the performance of GPR (AUROC=0.66, 95% CI 0.60-0.72) was higher than APRI (AUROC=0.58, 95% CI 0.52-0.64, P=.002) and Fib-4 scores (AUROC=0.54, 95% CI 0.47-0.60, P<.001). After estimating the AUROC to predict severe fibrosis, the performance of GPR (AUROC=0.71, 95% CI 0.63-0.80) was also higher than APRI (AUROC=0.65, 95% CI 0.56-0.73, P=.003) and Fib-4 scores (AUROC=0.67, 95% CI 0.58-0.75, P=.001). After estimating the AUROC to predict cirrhosis, the performance of GPR (AUROC=0.73, 95% CI 0.56-0.88) was higher than APRI (AUROC=0.69, 95% CI 0.54-0.83, P=.041) and Fib-4 scores (AUROC=0.69, 95% CI 0.55-0.82, P=.012) too. The GPR is a new serum model for the diagnosis of liver fibrosis and cirrhosis and shows obvious advantages in Chinese HBeAg-positive patients with HBV DNA≥5 log copies/mL and ALT≤2 ULN compared with APRI and Fib-4, thus warranting its widespread use for this specific population.

A diagnostic algorithm for assessment of liver fibrosis by liver stiffness measurement in patients with chronic hepatitis B

“…The problem goes to how we identify this subgroup of CHB patients accurately without liver biopsy. APRI and GPR have been proposed to evaluate hepatic fibrosis accurately in CHB patients . In addition, our multivariate analysis revealed that AST and GGT were independent factors of advanced fibrosis.…”

“…and Li et al. in which GPR not only yielded good AUROC for predicting fibrosis but showed better performance as compared with APRI in Gambian and Chinese CHB cohorts . As GPR had a high NPV for the prediction of no advanced fibrosis at the cut‐off value of 0.17, we categorized patients with GPR <0.17 into the subgroup of low‐grade fibrosis.…”

King’s Fibrosis, Fibrosis Index, GPR, and ALBI Score Are Useful Models for Liver Fibrosis in Chronic Hepatitis B Patients Pre- and Post-Treatment

“…We found only Lemoine et al's study (11) to be similar to our study. It was conducted mainly in patients who were negative for HBeAg, while other studies enrolled all positive (21) or both patients (20,27,29,30). Another point is that most previous studies were conducted in China but our study and the study by Lemoine et al (11) were conducted in Africa.…”

Clinical and histopathological features of chronic hepatitis B virus infected patients with high HBV-DNA viral load and normal alanine aminotransferase level: A multicentre-based study in China

“…Therefore, the identification of patients with PNALT who still suffer from severe liver injury is challenging. Recently, indirect serum markers such as the FIB-4 index, APRI and GPR, which affect the ALT level and other serum parameters, have been proposed as clinical markers in routine laboratory measurements to predict the severity of liver damage [11, 18]. …”