August 5, 2010

A simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B

Journal of Gastroenterology and Hepatology
Published Online: 14 May 2010
Journal compilation © 2010 Blackwell Publishing Asia Pty Ltd and Journal of Gastroenterology and Hepatology Foundation

ZHOU Kun 1,4▵ , GAO Chun-fang 3▵ , ZHAO Yun-peng 3 , LIU Hai-lin 4 , ZHENG Rui-dan 5 , XIAN Jian-chun 6 , XU Hong-tao 6 , MAO Yi-min 1 , ZENG Min-de 1 , LU Lun-gen 1,2*

1 Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200001; 2 Department of Gastroenterology, Shanghai First People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200080,China

4 Department of Gastroenterology, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200011, China

3 Department of Laboratory Medicine, Eastern Hepatobiliary Hospital, Second Military Medical University, Shanghai 200433, China
5 Research and Therapy Center for Liver Diseases, Southeast Hospital, Zhangzhou, Fujian 363000,China
6 Department of Infectious Disease, Taizhou People's Hospital, Jiangsu 225300, China

Correspondence to *Dr. LU Lun-gen

▵These two authors contributed equally to this work.

Financial Support: This study was supported by the National Key Technologies Research and Development Program of China during the 11th Five-year Plan Period (2008ZX10002-006), the National High Technology Research and Development Program of China (863 Program,No:2006AA02A411), Science and Technology Commission of Shanghai Municipality (No:064119519), the Key Project of Shanghai Medical Development Foundation (No: 99ZDI001), and Shanghai Leading Academic Discipline Project (No:Y0205).

The funding sources had no involvement in study design, in the collection, analysis, and interpretation of data and so on.

This is an Accepted Article that has been peer-reviewed and approved for publication in the Journal of Gastroenterology and Hepatology, but has yet to undergo copy-editing and proof correction. Please cite this article as an "Accepted Article"; doi: 10.1111/j.1440-1746.2010.06383.x

liver biopsy • liver fibrosis • cirrhosis • noninvasive diagnosis • assessment


Background: In recent years, a great interest has been dedicated to the development of noninvasive predictive models to substitute liver biopsy for fibrosis assessment and follow-up.

Aims: To provide a simpler model consisting of routine laboratory markers for predicting liver fibrosis in patients chronically infected with hepatitis B virus (HBV) in order to optimize their clinical management.

Methods: Liver fibrosis was staged in 386 chronic HBV carriers who underwent liver biopsy and routine laboratory testing. Correlations between routine laboratory markers and fibrosis stage were statistically assessed. After logistic regression analysis, a novel predictive model was constructed. This S index was validated in an independent cohort of 146 chronic HBV carriers in comparison to the SLFG model, Fibrometer, Hepascore, Hui model, Forns score and APRI using receiver operating characteristic (ROC) curves.

Results: The diagnostic values of each marker panels were better than single routine laboratory markers. The S index consisting of γ-glutamyltransferase (GGT), platelets (PLT) and albumin (ALB) (S-index: 1000 × GGT / (PLT × ALB2)) had a higher diagnostic accuracy in predicting degree of fibrosis than any other mathematical model tested. The areas under the ROC curves (AUROC) were 0.812 and 0.890 for predicting significant fibrosis and cirrhosis in the validation cohort, respectively.

Conclusions: The S index, a simpler mathematical model consisting of routine laboratory markers predicts significant fibrosis and cirrhosis in patients with chronic HBV infection with a high degree of accuracy, potentially decrease the need for liver biopsy.

Accepted: 02 May 2010

10.1111/j.1440-1746.2010.06383.x About DOI

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