Comparison of noninvasive models of fibrosis in chronic hepatitis B
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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.
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.
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).
Serum fibrosis models are predictive of fibrosis in CHB and assist in identifying subjects with low–normal ALT levels for treatment.
KeywordsHepascore APRI Fibrotest Fibrosure Image morphometry
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.
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