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- Title
Diagnostic thresholds and performance of noninvasive fibrosis scores are limited by age in patients with chronic hepatitis B.
- Authors
Wang, Wentao; Zhao, Xueqi; Li, Guiping; Wang, Lin; Chen, Yizhi; Ma, Ke; Chen, Guang; Chen, Tao; Han, Meifang; Ning, Qin; Zhao, Xiping
- Abstract
Aim: We aimed at investigating the effects of age on the predictive performances of noninvasive fibrosis scores for significant fibrosis in patients with chronic hepatitis B (CHB). Methods: A total of 496 CHB patients who underwent liver biopsy were stratified into four age groups: ≤30, 31 to 40, 41 to 50, and ≥51 years. Receiver operating characteristic curves were used to evaluate the diagnostic performance of aspartate aminotransferase to platelet ratio index (APRI), fibrosis score‐4 (Fib‐4) and γ‐glutamyl transpeptidase to platelet ratio (GPR) in different age groups. Results: The extent of fibrosis significantly increased with age, and the percentage of significant fibrosis (≥F2) was 21.3%, 29.0%, 38.5%, and 46.1%, respectively. All three scores displayed a moderate accuracy to diagnose significant fibrosis in overall patients. However, for patients with age ≤30 years, APRI, Fib‐4, and GPR performed poorly with the AUROC of 0.567, 0.627 and 0.596, respectively. Furthermore, using the established cut‐off values—1.45 for Fib‐4, the sensitivity for significant fibrosis increased with age, from 14.8%, 38.1%, 74.5% to 97.87% in above age groups, respectively. To improve the diagnostic accuracy for significant fibrosis, the proposed low and high cut‐off points for Fib‐4 were 0.41 and 1.15 in ≤30 years, 0.8 and 1.59 in 31 to 40 years, 1.17 and 1.94 in 41 to 50 years, 1.76 and 3.10 in ≥ 51 years, respectively. Conclusions: Age may influence the diagnostic thresholds and performance of APRI, Fib‐4, and GPR for significant fibrosis in patients with CHB. In particular, these scores performed poorly for identifying significant fibrosis in younger patients (≤30 years). Highlights: 1. APRI, Fib‐4 and GPR had the low accuracy to diagnose significant fibrosis in younger CHB patients (≤30 years).2.The cut‐off points of APRI, Fib‐4 and GPR should be adjusted by age to improve the diagnostic accuracy for significant fibrosis. Taking Fib‐4 as an example, the LC and HC were 0.41 and 1.15 in ≤30 years, 0.8 and 1.59 in 31‐40 years, 1.17 and 1.94 in 41‐50 years, 1.76 and 3.10 in ≥51 years, respectively.
- Subjects
CHRONIC hepatitis B; CIRRHOSIS of the liver; GLUTAMYL-tRNA synthetase; ASPARTATE aminotransferase; RECEIVER operating characteristic curves
- Publication
Journal of Medical Virology, 2019, Vol 91, Issue 7, p1279
- ISSN
0146-6615
- Publication type
Article
- DOI
10.1002/jmv.25435