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Globulin–platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels

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Abstract

The globulin–platelet model (GP) is a new noninvasive liver fibrosis model developed in chronic hepatitis B (CHB) patients. This study aimed to evaluate the diagnostic performance of GP model for liver fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase (ALT) levels. We enrolled 316 CHB patients with HBV DNA ≥ 4 log 10 copies/mL and 40 IU/L < ALT ≤ 80 IU/L. The GP, aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) were calculated. Using liver histology as a gold standard, the diagnostic performances of noninvasive fibrosis models were compared by the area under receiver operating characteristic curves (AUROCs). Of 316 patients, 146 (46.2%), 64 (20.3%) and 40 (12.7%) were classified as having significant fibrosis, severe fibrosis and cirrhosis, respectively. To predict significant fibrosis, the AUROC of GP was lower than APRI (0.64 vs 0.76, p < 0.001) and equivalent to FIB-4 (0.64 vs 0.66, p = 0.366). To predict severe fibrosis, the AUROC of GP was equivalent to APRI (0.82 vs 0.79, p = 0.409) and FIB-4 (0.82 vs 0.77, p = 0.224). To predict cirrhosis, the AUROC of GP was higher than APRI (0.91 vs 0.84, p = 0.033) and FIB-4 (0.91 vs 0.80, p = 0.004). GP is a more accurate noninvasive fibrosis model than APRI and FIB-4 to diagnose cirrhosis in CHB patients with high HBV DNA and mildly elevated ALT levels. The clinical application of GP model may reduce the need for liver biopsy in CHB patients.

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Acknowledgements

This study was supported by Grant No. SHDC12015129 from the ShenKang Development Center of Shanghai, Grant No. 17411969700 from the Science and Technology Commission of Shanghai and Grant No. 13401902100 from the Science and Technology Commission of Shanghai.

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Authors and Affiliations

  1. Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China

    Qiang Li, Chuan Lu, Weixia Li, Yuxian Huang & Liang Chen

  2. Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, 200040, China

    Qiang Li & Yuxian Huang

Authors
  1. Qiang Li
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  2. Chuan Lu
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  3. Weixia Li
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  4. Yuxian Huang
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  5. Liang Chen
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Contributions

Qiang Li contributed to study concept and design and drafting of the manuscript. Liang Chen, Chuan Lu, Weixia Li, Yuxian Huang and Qiang Li helped in analysis and interpretation of data. Liang Chen critically revised the manuscript for important intellectual content.

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Correspondence to Qiang Li or Liang Chen.

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All the authors declare that they have no conflict of interest.

Ethical approval and Informed consent

All patients signed the informed consent before liver biopsy, and all clinical procedures were in accordance with the Helsinki Declaration of 1975, as revised in 1983. The study protocol was permitted by the Ethics Committee of Shanghai Public Health Clinical Center.

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Qiang Li is acting as the submission’s guarantor and takes responsibility for the integrity of the work as a whole, from inception to published article.

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Li, Q., Lu, C., Li, W. et al. Globulin–platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels. Clin Exp Med 18, 71–78 (2018). https://doi.org/10.1007/s10238-017-0472-3

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  • DOI: https://doi.org/10.1007/s10238-017-0472-3

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