Liver Int. 2017 Jun 5. doi: 10.1111/liv.13489. [Epub ahead of print]
Non-invasive tests for liver disease severity and the hepatocellular carcinoma risk in chronic hepatitis B patients with low level viremia.Paik N1, Sinn DH1, Lee JH1, Oh IS1, Kim JH1, Kang W1, Gwak GY1, Paik YH1, Choi MS1, Lee JH1, Koh KC1, Paik SW1. Author information 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
AbstractBACKGROUND & AIMS: We tested whether non-invasive tests for liver disease severity can stratify hepatocellular carcinoma (HCC) risk in chronic hepatitis B virus (HBV) infected patients showing low level viremia (LLV, HBV DNA < 2,000 IU/mL).
METHODS: A retrospective cohort of 1,006 chronic hepatitis B patients showing persistently LLV, defined by at least two consecutive assessments in the year before enrollment, was assessed for HCC development. Two non-invasive serum biomarkers, the aspartate aminotransferase to platelet ratio index (APRI) and the Fibrosis-4 (FIB-4), were tested. Cirrhosis was defined with ultrasonography.
RESULTS: During a median 5.1 years of follow-up, HCC developed in 36 patients. HCC incidence rate at 5 years was significantly higher for cirrhotic patients (19/139, 13.7%), but was not null for non-cirrhotic patients (17/867, 2.0%, P < 0.001). APRI at a cutoff of 0.5 was more specific but less sensitive for HCC development, and FIB-4 at a cutoff of 1.45 was more sensitive but less specific. When both APRI and FIB-4 were used to group patients, the 5-year cumulative HCC incidence rate was 13.9%, 1.4% and 1.2% for both high, any high, and both low APRI and FIB-4 score among all patients (n = 1,006, P < 0.001), respectively, and was 11.4%, 1.5% and 0.4% in the same respective order among non-cirrhotic patients (n = 867, P < 0.001).
CONCLUSION: The combined use of two non-invasive serum biomarkers (APRI and FIB-4) could stratify HCC risk for chronic HBV infected patients with LLV. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS: AST to platelet ratio index; Fibrosis-4 score; Hepatocellular carcinoma; Low level viremia