Prevalence and Serological Predictors of Liver Fibrosis in Vietnamese Chronic Hepatitis B Patients with Persistently Normal or Mildly Elevated Aminotransferase Level.

BACKGROUND

Chronic hepatitis B (CHB) remains a significant health concern, especially in low- and middle-income countries. Some CHB patients with normal or mildly elevated ALT may have advanced liver fibrosis, which often goes undetected.

OBJECTIVE

The aim of this study was to assess the prevalence of significant fibrosis and the diagnostic accuracy of serum markers in CHB patients with ALT <2× ULN in Vietnam.

METHODS

A cross-sectional study was conducted at 175 Military Hospital between October 2019 and December 2021. A total of 144 CHB patients with ALT <2× ULN were assessed for liver fibrosis using FibroScan (METAVIR criteria). The diagnostic accuracy of APRI and FIB-4 was evaluated using receiver operating characteristic (ROC) curves.

RESULTS

Among 144 participants, 26.4% exhibited advanced fibrosis (F≥2), including 9% with cirrhosis. Advanced fibrosis correlated with older age (50 vs. 42 years, p=0.012), male sex (p=0.024), higher AST, ALT, and GGT levels (p<0.05), and lower platelet counts (PLT) (p<0.001). APRI and PLT demonstrated the highest diagnostic accuracy (AUC=0.802 and 0.805, respectively). APRI achieved 84.2% sensitivity and 92.5%, negative predictive value (NPV), while PLT had the highest specificity (81.1%). FIB-4 (AUC=0.716), ALT (AUC=0.676), and prothrombin time (PT) (AUC=0.646), had moderate performance. Combining APRI and PLT significantly improved diagnostic accuracy (p<0.05).

CONCLUSION

Significant fibrosis was present in 26.4% of CHB patients with normal or mildly elevated ALT levels. APRI and PLT are reliable and cost-effective to detect early fibrosis in re-source-limited settings. These findings underscore the need to revise Vietnam's CHB management strategies for earlier fibrosis diagnosis and treatment.