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Development of a fibrosis index including hepatitis B virus basal core promoter A1762T mutation for pretherapeutic evaluation
Author(s) -
Yeh Christopher SungHuan,
Hsu ChaoWei,
Liang KungHao,
Chen YiCheng,
Lin ChihLang,
Chien RongNan,
Hu TsungHui,
Lin WeyRan,
Lai MingWei,
Chu YuDe,
Yeh ChauTing
Publication year - 2018
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.14120
Subject(s) - medicine , gastroenterology , fibrosis , cirrhosis , aspartate transaminase , receiver operating characteristic , cohort , liver biopsy , hepatology , biopsy , enzyme , biochemistry , chemistry , alkaline phosphatase
Background and Aim Commonly used non‐invasive fibrosis scores usually included serum transaminase levels in the equations, including Aspartate transaminase to Platelet Ratio Index (APRI) and fibrosis‐4 (FIB‐4). Transaminases fluctuated significantly in chronic hepatitis B patients with exacerbations, leading to unsteady score values. As such, here, we aim to develop a transaminase‐free score suitable for pretherapeutic evaluation of fibrosis stages. Methods Firstly, 1082 treatment‐naïve chronic hepatitis B patients were enrolled and divided into modeling ( n = 541) and verification ( n = 541) cohorts. Secondly, 265 patients having received liver biopsy, with known Ishak fibrosis stages, were included for independent correlation. Results Cross‐sectional analysis of 1082 patients revealed age‐dependent variation of association between virological factors and cirrhosis. A fibrosis score including Anti‐hepatitis B e antibody, Basal core promoter (BCP) A1762T mutation, and Platelet count Index (named ABPI) was derived from the modeling cohort. ABPI performed better than APRI and FIB‐4 in the verification cohort for identifying cirrhotic patients (comparison of area under the receiver operating characteristic curves: ABPI vs APRI and FIB‐4 = 0.785 vs 0.563 [ P < 0.001] and 0.700 [ P = 0.026], respectively). The performance of ABPI was even better in young (< 40 years old) hepatitis B patients (area under the receiver operating characteristic curves: 0.856 vs 0.402 [ P < 0.001] and 0.599 [ P = 0.009], respectively). Finally, in the independent cohort of 265 patients with known Ishak fibrosis stages, it was found that ABPI effectively distinguished between Ishak fibrosis stages 3 and > 3 and between 4 and > 4 ( P < 0.001 for each). Conclusions We developed a transaminase‐free fibrosis score (ABPI) utilizing basal core promoter A1762T data, which outperformed APRI and FIB‐4.