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Performance of Risk Estimation for Hepatocellular Carcinoma in Chronic Hepatitis B ( REACH ‐B) score in classifying treatment eligibility under 2012 Asian Pacific Association for the Study of the Liver ( APASL ) guideline for chronic hepatitis B patients
Author(s) -
Chen T.M.,
Chang C.C.,
Huang P.T.,
Wen C.F.,
Lin C.C.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12144
Subject(s) - medicine , hepatocellular carcinoma , odds ratio , confidence interval , guideline , gastroenterology , hepatitis b , hbeag , logistic regression , chronic hepatitis , receiver operating characteristic , liver cancer , hepatitis b virus , immunology , pathology , hbsag , virus
Summary Background REACH ‐B [Risk Estimation for Hepatocellular Carcinoma ( HCC ) in Chronic Hepatitis B] scoring system was developed to predict the risk of HCC in noncirrhotic chronic hepatitis B ( CHB ) patients. Aim To evaluate the discriminatory performance of REACH ‐B scoring system in classifying anti‐viral treatment eligibility of CHB patients according to the 2012 Asian Pacific Association for the Study of the Liver ( APASL ) treatment guideline. Methods A total of 904 noncirrhotic CHB were enrolled. Patients' age, gender, liver biochemistry, HB eAg status and HBV DNA levels were recorded. Results The minimum REACH ‐B risk score for patients to be eligible for anti‐viral treatment was 7 for HB eAg‐positive and 6 for HB eAg‐negative patients. Among them, increasing REACH ‐B score was not significantly associated with eligibility for treatment [adjusted odds ratio ( OR ): 1.210, 95% confidence interval ( CI ): 0.979–1.494, P = 0.078] in HBeAg‐positive patients, as shown by logistic regression analysis after adjusting for gender. In HBeAg‐negative patients, REACH ‐B score significantly predicted the treatment eligibility (adjusted OR : 1.783, 95% CI : 1.607–1.979, P < 0.001). Discriminatory ability of REACH ‐B score to classify eligibility was poor for HBeAg‐positive patients ≥40 years [area under receiver operating characteristic ( AUC ): 0.664, 95% CI : 0.533–0.795], but good/excellent for HB eAg‐positive patients <40 years ( AUC : 0.903; 95% CI : 0.841–0.964), HB eAg‐negative patients ≥45 years ( AUC : 0.883; 95% CI : 0.848–0.917) and HB eAg‐negative patients <45 years ( AUC : 0.907; 95% CI : 0.874–0.940). Conclusion The discriminatory performance of the REACH ‐B scoring system in classifying anti‐viral treatment eligibility based on the 2012 APASL guideline was good/excellent, except for ≥40 years old HB eAg‐positive patients.