Diminished accuracy of biomarkers of fibrosis in low replicative chronic hepatitis B

We evaluated the diagnostic accuracy of aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), AST/alanine aminotransferase (ALT) ratio (AAR), and age-platelet index (API) for significant fibrosis (Metavir F2-4) in low-replicative (HBV DNA <20,000 IU/mL) chroni...

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Published in:	BMC gastroenterology Vol. 17; no. 1; p. 101
Main Authors:	Sanai, Faisal M, Farah, Taha, Albeladi, Khalid, Batwa, Faisal, Dahlan, Yaser, Babatin, Mohammed A, Al-Ashgar, Hamad, AlMana, Hadeel, Alsaad, Khaled S, AlSwat, Khalid, Aljumah, Abdulrahman, AlTraif, Ibrahim H, Kailani, Bahaa E, Bzeizi, Khalid I
Format:	Journal Article
Language:	English
Published:	England BioMed Central Ltd 25-08-2017 BioMed Central BMC
Subjects:	Accuracy Adult Age Alanine Alanine transaminase Alanine Transaminase - blood Antigens APRI Area Under Curve Aspartate aminotransferase Aspartate Aminotransferases - blood Biological markers Biomarkers Biomarkers - blood Biopsy Complications and side effects Deoxyribonucleic acid Diagnosis DNA DNA Replication DNA, Viral - blood Female Fibrosis Gastroenterology Genetic aspects Hepatitis Hepatitis B Hepatitis B e antigen Hepatitis B virus - genetics Hepatitis B virus - physiology Hepatitis B, Chronic - blood Hepatitis B, Chronic - complications Hepatology Humans Infections Interferon Laboratories Liver Cirrhosis - blood Liver Cirrhosis - virology Liver diseases Male Middle Aged Physiological aspects Platelet Count - statistics & numerical data Platelets Reference Values Reproducibility of Results Risk factors Sensitivity and Specificity Studies Variables Virus Replication Saudi Arabia APRI Biomarkers Fibrosis Hepatitis B
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Summary:	We evaluated the diagnostic accuracy of aspartate aminotransferase (AST)-to-platelet ratio index (APRI), fibrosis-4 index (FIB-4), AST/alanine aminotransferase (ALT) ratio (AAR), and age-platelet index (API) for significant fibrosis (Metavir F2-4) in low-replicative (HBV DNA <20,000 IU/mL) chronic hepatitis B virus (HBV) patients. The sensitivity, specificity, and area under the receiver-operating characteristic curve (AUROC) of HBeAg-negative, low-replicative (n = 213) and high-replicative (HBV DNA ≥20,000 IU/mL, n = 153) patients was assessed. Overall, 113 patients (30.9%) had F2-4 fibrosis. Of the low and high-replicative patients, 40 (18.8%) and 73 (47.7%) had F2-4, respectively (P < 0.0001). APRI ≥0.5 less frequently identified F2-4 fibrosis in low vs. high-replicative patients (48.7% vs. 69.6%, P = 0.032) and AAR identified it more frequently in low-replicative patients (37.5% vs. 19.4%, P = 0.037). FIB-4 and API were not different (P > 0.05) for identifying F2-4 fibrosis in low and high-replicative patients. Higher specificities were seen at the lowest cut-offs in low vs. high-replicative states for APRI (≥0.5, 98% vs. 68.9%), AAR (84.3% vs. 76.6%), FIB-4 (≥1.45, 97.5% vs. 87.8%) and API (>4, 94.8% vs. 93.8%). At ROC-defined thresholds, APRI (≥0.33), AAR (≥0.93), FIB-4 (≥0.70) and API (>2) showed greater AUROCs for F2-4 diagnosis in low replicative (0.80, 0.62, 0.81 and 0.71, respectively) vs. high-replicative patients (0.73, 0.52, 0.67 and 0.69, respectively). All 4 biomarkers in both, low and high-replicative HBV demonstrate modest accuracy for fibrosis diagnosis at conventional cut-offs. Lowering the cut-offs may increase the diagnostic relevance of these biomarkers, particularly for APRI and FIB-4 in low-replicative disease.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1471-230X 1471-230X
DOI:	10.1186/s12876-017-0658-x