Department of Infectious DiseasesInstitute for Viral HepatitisThe Key Laboratory of Molecular Biology for Infectious DiseasesChinese Ministry of EducationThe Second Affiliated Hospital of Chongqing Medical UniversityChongqingChina.
Public Health Clinical Center of ChengduChengduChina.
Hepatol Commun. 2022 Jul;6(7):1664-1672. doi: 10.1002/hep4.1938. Epub 2022 Mar 21.
Accurate prediction of the extent of fibrosis is of great clinical importance in patients infected with chronic hepatitis B (CHB). This study aimed to compare the performance of gamma-glutamyl transpeptidase-to-platelet ratio (GPR), aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) in evaluating liver fibrosis stages and to identify optimized cutoffs to exclude cirrhosis. Consecutive patients with CHB with liver biopsies were enrolled and randomly divided into derivation and validation cohorts. Areas under the receiver operating characteristic curve were used to evaluate the diagnostic performance of APRI, FIB-4, and GPR to distinguish fibrosis stages. New cutoffs with a sensitivity of at least 90% and a negative predictive value (NPV) of more than 95% were identified. A total of 880 individuals were enrolled in this study. The derivation data set consisted of 617 patients, with 82 patients with cirrhosis. In the validation cohort (n = 263), 29 patients had cirrhosis. APRI, FIB-4, and GPR had comparable diagnostic performance for diagnosing significant fibrosis. GPR outperformed APRI (p < 0.05) in the prediction of cirrhosis. A newly identified GPR score of 0.35 had a sensitivity and NPV of 93.9% and 98.0%, respectively, and misclassified 5 of 82 (6.1%) patients with cirrhosis in the derivation group. All new cutoffs identified in this study also reached our goal in the validation cohort. The new GPR score could rule out a larger proportion of individuals without cirrhosis, and the subgroup analysis showed more stable performance. However, the lower cutoff dose increases the need for further testing compared to the conventional cutoff. Conclusion: A newly identified cutoff for GPR (<0.35) could rule out more patients without cirrhosis compared to APRI and FIB-4 and have low misclassification rates.
准确预测纤维化程度在慢性乙型肝炎 (CHB) 感染患者中具有重要的临床意义。本研究旨在比较γ-谷氨酰转肽酶/血小板比值 (GPR)、天冬氨酸氨基转移酶/血小板比值指数 (APRI) 和纤维化-4 (FIB-4) 在评估肝纤维化分期方面的性能，并确定优化的截断值以排除肝硬化。本研究纳入了连续接受肝活检的 CHB 患者，并将其随机分为推导队列和验证队列。使用受试者工作特征曲线下面积评估 APRI、FIB-4 和 GPR 区分纤维化分期的诊断性能。确定了新的截断值，其灵敏度至少为 90%，阴性预测值 (NPV) 大于 95%。本研究共纳入 880 例患者。推导数据集包括 617 例患者，其中 82 例患者患有肝硬化。在验证队列 (n = 263) 中，有 29 例患者患有肝硬化。APRI、FIB-4 和 GPR 对诊断显著纤维化的诊断性能相当。GPR 在预测肝硬化方面优于 APRI (p < 0.05)。新确定的 GPR 评分 0.35 的灵敏度和 NPV 分别为 93.9%和 98.0%，在推导组中误分类了 82 例肝硬化患者中的 5 例 (6.1%)。本研究中确定的所有新截断值在验证队列中也达到了我们的目标。新的 GPR 评分可以排除更多没有肝硬化的个体，亚组分析显示出更稳定的性能。然而，与常规截断值相比，较低的截断剂量会增加进一步检测的需求。结论：与 APRI 和 FIB-4 相比，新确定的 GPR (<0.35) 截断值可排除更多没有肝硬化的患者，且误诊率较低。
