Comparison of noninvasive models of fibrosis in chronic hepatitis B

• Published in: Hepatology international Vol. 6; no. 2; pp. 457 - 467
• Main Authors: Raftopoulos, S. C., George, J., Bourliere, M., Rossi, E., de Boer, W. B., Jeffrey, G. P., Bulsara, M., Speers, D. J., MacQuillan, G., Ching, H. L. I., Kontorinis, N., Cheng, W., Flexman, J., Fermoyle, S., Rigby, P., Walsh, L., McLeod, D., Adams, L. A.
• Format: Journal Article
• Language: English
• Published: India Springer-Verlag 01-04-2012; Springer Nature B.V
• Subjects: Alanine transaminase; Colorectal Surgery; Fibrosis; Hepatitis B; Hepatology; Liver; Medicine; Medicine & Public Health; Original Article; Surgery; APRI; Fibrotest; Hepascore; Fibrosure; Image morphometry
• ISSN: 1936-0533; 1936-0541
• DOI: 10.1007/s12072-011-9296-5

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.