A new combined predicting model using a non-invasive score for the assessment of liver fibrosis in patients presenting with chronic hepatitis B virus infection - 16/11/19
Un nouveau modèle combiné prédictif utilisant un score non invasif pour l’évaluation de la fibrose hépatique chez les patients ayant une hépatite B chronique
, M. Koubaa b, S. Yaich a, K. Rekik b, T. Ben Jemaa b, I. Maaloul b, C. Marrekchi b, J. Damak a, M. Ben Jemaa bBenvenuto su EM|consulte, il riferimento dei professionisti della salute.
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Highlights |
• | Histological staging of liver fibrosis is a crucial step to identify the therapeutic strategy in patients presenting with chronic hepatitis B infection. |
• | Several non-invasive scores have recently been validated to assess liver fibrosis. |
• | These scores are of major interest, as they may accurately predict liver fibrosis without percutaneous liver biopsy. |
• | This is the first study that combined two biological non-invasive scores (APRI and FIB-4) in predicting liver fibrosis in patients presenting with chronic hepatitis B infection. |
• | We proposed a useful stepwise algorithm in chronic hepatitis B infection management to select patients who really need percutaneous liver biopsy. |
Abstract |
Objectives |
Several non-invasive markers have recently been proposed to predict liver fibrosis without percutaneous liver biopsy (PLB). We aimed to evaluate the performance of non-invasive scores and to highlight the value of a new combined score in the prediction of liver fibrosis in chronic hepatitis B (CHB) patients.
Patients and methods |
We performed a retrospective study of patients presenting with CHB who underwent PLB between 2008 and 2016. We calculated ASAT/Platelet Ratio Index (APRI), Fibrosis-4 Score (FIB4), GGT-to-platelet ratio (GPR), and ASAT/ALAT Ratio (AAR). Then, we combined APRI and FIB-4 scores into a new combined score. We assessed their performance in predicting liver fibrosis according to the Metavir score.
Results |
A total of 179 patients presenting with CHB were included. Multivariate analysis showed that the APRI score was the only independent factor of significant fibrosis (OR=3.78; P=0.02), whereas the FIB-4 score was the only independent factor for severe fibrosis (OR=2.85; P<0.001) and cirrhosis (OR=2.5; P=0.001). At a threshold of severe fibrosis, APRI had the best specificity (75%) and FIB-4 had the greatest sensitivity (74%). Using the combined score, we improved the diagnostic performance of APRI and FIB-4 scores at the three thresholds of liver fibrosis. With this combined score, maximum 25.1% of patients presenting with CHB would undergo PLB.
Conclusion |
APRI, FIB-4, and GPR scores were well performing to predict liver fibrosis during CHB. The new combined score using APRI and FIB-4 was more accurate at the three-fibrosis thresholds.
Il testo completo di questo articolo è disponibile in PDF.Résumé |
Objectifs |
Récemment, plusieurs marqueurs non invasifs étaient proposés pour prédire la fibrose hépatique sans recours à la ponction biopsie du foie (PBF). Notre objectif était d’évaluer la performance des scores non invasifs et de démontrer l’intérêt d’un nouveau score combiné dans la prédiction de la fibrose hépatique chez les patients atteints d’hépatite B chronique (HBC).
Patients et méthodes |
Notre étude rétrospective portait sur les patients atteints d’HBC ayant subi une PBF entre 2008–2016. Nous avons calculé ASAT/Platelet Ratio Index (APRI), Fibrosis-4 Score (FIB-4), GGT-to-platelet ratio (GPR) et ASAT/ALAT Ratio (AAR). Nous avons combiné APRI et FIB-4 en un nouveau score. Nous avons évalué leurs performances dans la prédiction de la fibrose hépatique selon le score Metavir.
Résultats |
Un total de 179 patients atteints d’HBC ont été inclus. L’analyse multivariée a montré que le score APRI était le seul facteur indépendant de fibrose significative (OR=3,78 ; p=0,02), alors que le score FIB-4 était le seul facteur indépendant de fibrose sévère (OR=2,85 ; p<0,001) et de cirrhose (OR=2,5 ; p=0,001). Au seuil d’une fibrose sévère, APRI avait la meilleure spécificité (75 %) et FIB-4 avait la meilleure sensibilité (74 %). La précision diagnostique du score combiné était meilleure aux trois seuils de fibrose hépatique. En utilisant ce score, 25,1 % des patients au maximum devraient bénéficier d’une PBF.
Conclusion |
APRI, FIB-4 et GPR étaient performants dans la prédiction de la fibrose hépatique au cours de l’HBC. Le nouveau score combinant APRI et FIB-4 était plus précis aux trois seuils de fibrose hépatique.
Il testo completo di questo articolo è disponibile in PDF.Keywords : Chronic hepatitis B, Fibrosis, Metavir score, Percutaneous liver biopsy
Mots clés : Hépatite B chronique, Fibrose, Score Metavir, Ponction biopsie hépatique
Mappa
Vol 49 - N° 8
P. 607-615 - novembre 2019 Ritorno al numero
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