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Performance of simple noninvasive scoring systems for the prediction of advanced fibrosis in patients with chronic hepatitis B

Lang, Sonja; Kütting, Fabian; Staub, Agnes; Schramowski, Jessica; Schramm, Christoph; Kasper, Philipp; Goeser, Tobias; Steffen, Hans-Michael; Demir, Münevver

European Journal of Gastroenterology & Hepatology: November 2017 - Volume 29 - Issue 11 - p 1235–1240
doi: 10.1097/MEG.0000000000000977
Original Articles: Hepatitis

Background and aim: The aim of the study was to analyze the diagnostic performance and clinical utility of simple noninvasive tests for the detection of advanced fibrosis in patients with chronic hepatitis B (CHB) infection seen at a tertiary referral center in Germany.

Patients and methods: We retrospectively analyzed 239 adult CHB patients with available liver biopsies. Patient demographics, hepatitis B markers, antiviral treatment, laboratory parameters, results from liver imaging, and histology were recorded. The sensitivity, specificity, and positive and negative predictive values were determined along with the area under receiver operating characteristic curves (AUROC) using published formulas and cut-off values for fibrosis index based on the four factors, aspartate aminotransferase–alanine aminotransferase ratio index (AAR), aspartate aminotransferase-to-platelet ratio index (APRI), and age–platelet index.

Results: The median documented duration of CHB infection was 31 months (range: 6–340 months); 86% of the patients were Caucasian and 71% were men. The AUROCs for the detection of advanced fibrosis were 0.75 [95% confidence interval (CI): 0.67–0.82], 0.72 (95% CI: 0.64–0.80), 0.48 (95% CI: 0.39–0.56), and 0.73 (95% CI: 0.66–0.81) for fibrosis index the four factors, APRI, AAR, and age–platelet index, respectively. Patients with advanced fibrosis on biopsy were misclassified as having mild fibrosis in 35% (APRI) to 82% (AAR) of cases.

Conclusion: Because of their moderate test performance (AUROCs: 0.48–0.75) and their high misclassification rate, we could not confirm a reliable clinical utility for the analyzed noninvasive fibrosis scoring systems for the prediction of advanced fibrosis in mostly Caucasian CHB patients.

Clinic for Gastroenterology and Hepatology, University of Cologne, Cologne, Germany

Correspondence to Sonja Lang, MD, Clinic for Gastroenterology and Hepatology, University Hospital of Cologne, D-50924 Koeln, Germany Tel: +49 221 4788 6109; fax: +49 221 4788 6581; e-mail: sonja.lang@uk-koeln.de

Received June 2, 2017

Accepted August 8, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.