HBV DNA level to predict liver fibrosis in HBeAg negative chronic hepatitis B patients with biopsy indication

2014 BMC Gastroenterology 14;1 (218)

BackgroundNon-invasive models and methods to substitute liver biopsy in chronic hepatitis B (CHB) patients were investigated but their roles as predictors of significant liver histology for diagnosis of HBeAg-negative CHB patients who had indication for liver biopsy according to The American Association for the Study of Liver Diseases (AASLD) and The Asian Pacific Association for the Study of the Liver (APASL) guidelines are still unknown. This study was designed to identify predictors of significant liver necroinflammation as defined by a Histology Activity Index of necroinflammatory score inverted question mark inverted question mark inverted question mark4 or Metavir necroinflammatory activity score inverted question mark inverted question mark inverted question mark2 and significant liver fibrosis as defined by a Metavir fibrosis score inverted question mark inverted question mark inverted question mark2 in HBeAg-negative CHB patients that had a hepatitis B virus (HBV) DNA level inverted question mark inverted question mark inverted question mark2,000 IU/ml and age inverted question mark inverted question mark inverted question mark40 years or elevated alanine aminotransferase level between 1 inverted question mark2 times the upper limit of normal.MethodsTwenty-two patients were prospectively included and performed liver biopsies. Clinical and laboratory parameters including age, gender, underlying disease, family history of cirrhosis or hepatocellular carcinoma, body mass index (BMI), HBV DNA level, HBsAg level, liver function test, complete blood count, aspartate aminotransferase-to-platelet ratio index and transient elastography were collected and analyzed with liver histology profiles.ResultsFive patients (23%) had significant liver inflammation and 7 patients (32%) had significant liver fibrosis. Factors associated with significant liver inflammation were a lower BMI and higher alkaline phosphatase level while a factor associated with significant liver fibrosis was lower age. On multivariate analysis, only HBV DNA level inverted question mark> inverted question mark5.5 log IU/ml could predict significant liver fibrosis (odds ratio 28.012, 95% CI, 1.631-481.240, p inverted question mark= inverted question mark0.022) and its sensitivity, specificity, positive predictive value and negative predictive value were 71.4%, 93.3%, 83.3% and 87.5% respectively.ConclusionsAn HBV DNA level of inverted question mark> inverted question mark5.5 log IU/ml was able to predict significant liver fibrosis for treatment of HBeAg-negative CHB patients that had indication for liver biopsy as recommended by AASLD and APASL guidelines.

Pubmed : 25523185