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Prediction of significant fibrosis in HBeAg‐positive patients with chronic hepatitis B by a noninvasive model
Author(s) -
Zeng MinDe,
Lu LunGen,
Mao YiMin,
Qiu DeKai,
Li JiQiang,
Wan MoBin,
Chen ChengWei,
Wang JiYao,
Cai Xiong,
Gao ChunFang,
Zhou XiaQiu
Publication year - 2005
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.20960
Subject(s) - medicine , gastroenterology , cutoff , receiver operating characteristic , hbeag , fibrosis , liver biopsy , hepatitis b , predictive value , chronic hepatitis , liver fibrosis , hepatitis b virus , biopsy , hbsag , immunology , virus , physics , quantum mechanics
Abstract A model was constructed consisting of clinical and serum variables to discriminate between hepatitis B e antigen (HBeAg)‐positive chronic hepatitis B (CHB) patients with and without significant fibrosis (stages 2‐4 vs. stages 0‐1). Consecutive treatment‐naive CHB patients who underwent liver biopsy were divided into 2 sequential groups: a training group (n = 200) and a validation group (n = 172). Multivariate analysis identified α2‐macroglobulin, age, gamma glutamyl transpeptidase, and hyaluronic acid as independent predictors of fibrosis. The area under the receiver operating characteristic curve was 0.84 for the training group and 0.77 for the validation group. Using a cutoff score of <3.0, the presence of significant fibrosis (F2 to F4) could be excluded with high accuracy (86.1% negative predictive value [NPV], 70.1% positive predictive value [PPV], and 94.8% sensitivity) in 43 (21.5%) of 200 patients in the training group, and with the same certainty (90.9% NPV, 64.7% PPV, and 98.0% sensitivity) in 22 (12.8%) of 172 patients in the validation group. Similarly, applying a cutoff score of >8.7, the presence of significant fibrosis could be correctly identified with high accuracy (91.1% PPV, 51.6% NPV, and 95.2% specificity) in 41 (20.5%) of 200 patients in the training group, and with the same certainty (84.8% PPV, 52.4% NPV, and 90.4% specificity) in 39 (22.7%) of 172 patients of the validation group. In conclusion , a predictive model with a combination of easily accessible variables identified HBeAg‐positive CHB patients with and without significant fibrosis with a high degree of accuracy. Application of this model may decrease the need for liver biopsy in staging of 35.5% CHB. (H EPATOLOGY 2005;42:1437–1445.)