Skip to main content

Advertisement

SpringerLink
Log in

Comparison of noninvasive models of fibrosis in chronic hepatitis B

  • Original Article
  • Published:
Hepatology International Aims and scope Submit manuscript

Abstract

Background and goals

Liver fibrosis influences treatment and surveillance strategies in chronic hepatitis B (CHB). This multicenter study aimed to examine the accuracy of serum fibrosis models in CHB patients including those with low alanine aminotransferase (ALT) levels and serially in those undergoing treatment.

Method

We examined noninvasive fibrosis models [Hepascore, Fibrotest, APRI, hepatitis e antigen (HBeAg)-positive and -negative models] in 179 CHB patients who underwent liver biopsy and fibrosis assessment by METAVIR and image morphometry. Serial Hepascore measurements were assessed in 40 subjects for up to 8.7 years.

Results

Hepascore was more accurate than Fibrotest [area under the curve (AUC) 0.83 vs. 0.72, P = 0.05] and HBeAg-positive model (AUC 0.83 vs. 72, P = 0.03) for significant fibrosis but was not significantly different to APRI or HBeAg-negative scores. Fibrosis area assessed by morphometry was correlated with Hepascore (r = 0.603, P < 0.001), Fibrotest (r = 0.392, P = 0.03), and HBeAg-positive (r = 0.492, P = 0.001) scores only. Among 73 patients with an ALT <60 IU/L, noninvasive models were useful to predict fibrosis (PPV 80–90%) or exclude significant fibrosis (NPV 79–100%). Hepascore increased significantly among patients monitored without treatment and reduced among patients undergoing therapy (0.05/year ± 0.03 vs. −0.04/year ± 0.02, P = 0.007).

Conclusions

Serum fibrosis models are predictive of fibrosis in CHB and assist in identifying subjects with low–normal ALT levels for treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Lee WM. Hepatitis B virus infection. N Engl J Med 1997;337:1733–1745

    Article  PubMed  CAS  Google Scholar 

  2. Sorrell MF, Belongia EA, Costa J, et al. National Institutes of Health Consensus Development conference statement: management of hepatitis B. Ann Intern Med 2009;150:104–110

    PubMed  Google Scholar 

  3. Belongia EA, Costa J, Gareen IF, et al. NIH consensus development statement on management of hepatitis B. NIH Consens State Sci Statements 2008;25:1–29

    PubMed  CAS  Google Scholar 

  4. McGill DB, Rakela J, Zinsmeister AR, Ott BJ. A 21-year experience with major hemorrhage after percutaneous liver biopsy. Gastroenterology 1990;99:1396–1400

    PubMed  CAS  Google Scholar 

  5. Van Thiel DH, Gavaler JS, Wright H, Tzakis A. Liver biopsy. Its safety and complications as seen at a liver transplant center. Transplantation 1993;55:1087–1090

    Article  PubMed  Google Scholar 

  6. Marcellin P, Asselah T, Boyer N. Fibrosis and disease progression in hepatitis C. Hepatology 2002;36:S47–S56

    Article  PubMed  Google Scholar 

  7. Kumar M, Sarin SK, Hissar S, et al. Virologic and histologic features of chronic hepatitis B virus-infected asymptomatic patients with persistently normal ALT. Gastroenterology 2008;134:1376–1384

    Article  PubMed  Google Scholar 

  8. Lai M, Hyatt BJ, Nasser I, Curry M, Afdhal NH. The clinical significance of persistently normal ALT in chronic hepatitis B infection. J Hepatol 2007;47:760–767

    Article  PubMed  CAS  Google Scholar 

  9. Zeng M, Lu LG, Mao Y, et al. Prediction of significant fibrosis in HBeAg-positive patients with chroic hepatitis B by a noninvasive model. Hepatology 2005;42:1437–1445

    Article  PubMed  Google Scholar 

  10. Mohamadnejad M, Montazeri G, Fazlollahi A, et al. Noninvasive markers of liver fibrosis and inflammation in chronic hepatitis B-virus related liver disease. Am J Gastroenterol 2006;101:2345–2537

    Article  Google Scholar 

  11. Adams LA, Bulsara M, Rossi E, et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005;51:1867–1873

    Article  PubMed  CAS  Google Scholar 

  12. Castera L, Vergniol J, Foucher J, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic Hepatitis C. Gastroenterology 2005;128:343–350

    Article  PubMed  Google Scholar 

  13. Chun-Tao W, Joel KG, Robert JF, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518–526

    Google Scholar 

  14. Goodman ZD, Stoddard AM, Bonkovsky HL, et al. Fibrosis progression in chronic hepatitis C: morphometric image analysis in the HALT-C trial. Hepatology 2009;50:1738–1749

    Article  PubMed  Google Scholar 

  15. Hu KQ, Schiff ER, Kowdley KV, et al. Histologic evidence of active liver injury in chronic hepatitis B patients with normal range or minimally elevated alanine aminotransferase levels. J Clin Gastroenterol 2010;44:510–516

    PubMed  Google Scholar 

  16. Rossi E, Adams L, Prins A, et al. Validation of the FibroTest biochemical markers score in assessing liver fibrosis in hepatitis C patients. Clin Chem 2003;49:450–454

    Article  PubMed  CAS  Google Scholar 

  17. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative study group. Hepatology 1996;24:289–293

    Article  PubMed  CAS  Google Scholar 

  18. Bottero J, Lacombe K, Guechot J, et al. Performance of 11 biomarkers for liver fibrosis assessment in HIV/HBV co-infected patients. J Hepatol 2009;50:1074–1083

    Article  PubMed  CAS  Google Scholar 

  19. Myers RP, Tainturier MH, Ratziu V, et al. Prediction of liver histological lesions with biochemical markers in patients with chronic hepatitis B. J Hepatol 2003;39:222–230

    Article  PubMed  CAS  Google Scholar 

  20. Afdhal NH, Curry M. Technology evaluation: a critical step in the clinical utilization of novel diagnostic tests for liver fibrosis. J Hepatol 2007;46:543–545

    Article  PubMed  Google Scholar 

  21. Lok AS, McMahon BJ. Chronic hepatitis B: update 2009. Hepatology 2009;50:661–662

    Article  PubMed  Google Scholar 

  22. Dienstag JL, Goldin RD, Heathcote EJ, et al. Histological outcome during long-term lamivudine therapy. Gastroenterology 2003;124:105–117

    Article  PubMed  CAS  Google Scholar 

  23. Hadziyannis SJ, Tassopoulos NC, Heathcote EJ, et al. Long-term therapy with adefovir dipivoxil for HBeAg-negative chronic hepatitis B for up to 5 years. Gastroenterology 2006;131:1743–1751

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors acknowledge the facilities, scientific and technical assistance of the Australian Microscopy and Microanalysis Research Facility at the Centre for Microscopy, Characterization and Analysis, The University of Western Australia, a facility funded by The University, State, and Commonwealth Governments. This study was sponsored by a Seeding Research Grant from the University of Western Australia, Faculty of Medicine, Dentistry and Health Sciences, and a Clinical Research Grant from Bristol Meyers Squibb Australia Pvt Ltd.

Conflict of interest

The University of Western Australia (employers of LAA, ER, GPJ, MB,) has a licensing agreement with Quest Diagnostics regarding Hepascore. JG is supported by a STREP grant from The Cancer Council NSW and the Robert W. Storr Bequest to the University of Sydney.

Author information

Authors and Affiliations

  1. Department of Gastroenterology, Sir Charles Gairdner Hospital, Perth, Australia

    S. C. Raftopoulos, G. P. Jeffrey, G. MacQuillan & L. A. Adams

  2. Storr Liver Unit, Westmead Millenium Institute, Westmead Hospital, University of Sydney, Sydney, Australia

    J. George

  3. Service d’Hépato-Gastroentérologie, Hôpital Saint Joseph, Marseille, France

    M. Bourliere

  4. Department of Clinical Microbiology, PathWest Laboratory Medicine, Perth, Australia

    E. Rossi, W. B. de Boer, D. J. Speers, J. Flexman & S. Fermoyle

  5. School of Medicine and Pharmacology, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, 6009, Australia

    G. P. Jeffrey, G. MacQuillan, H. L. I. Ching & L. A. Adams

  6. Department of Statistics, Notre Dame University, Fremantle, Australia

    M. Bulsara

  7. Department of Gastroenterology, Royal Perth Hospital, Perth, Australia

    N. Kontorinis & W. Cheng

  8. Center for Microscopy, Characterisation and Analysis, University of Western Australia, Perth, Australia

    P. Rigby & L. Walsh

  9. Department of Anatomical Pathology, Westmead Hospital, University of Sydney, Sydney, Australia

    D. McLeod

Authors
  1. S. C. Raftopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. George
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Bourliere
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. Rossi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. B. de Boer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. G. P. Jeffrey
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. M. Bulsara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. D. J. Speers
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. G. MacQuillan
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. H. L. I. Ching
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. N. Kontorinis
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. W. Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J. Flexman
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. S. Fermoyle
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. P. Rigby
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. L. Walsh
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. D. McLeod
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. L. A. Adams
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. A. Adams.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Raftopoulos, S.C., George, J., Bourliere, M. et al. Comparison of noninvasive models of fibrosis in chronic hepatitis B. Hepatol Int 6, 457–467 (2012). https://doi.org/10.1007/s12072-011-9296-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12072-011-9296-5

Keywords

Search

Navigation