J Med Virol. 2019 Feb 20. doi: 10.1002/jmv.25435. [Epub ahead of print]
Diagnostic Thresholds and Performance of Non-invasive Fibrosis Scores are Limited by Age in Patients with Chronic Hepatitis B.
Wang W1,2, Zhao X3, Li G4, Wang L1, Chen Y5, Ke M1, Chen G1, Chen T1, Meifang H1, Ning Q1, Zhao X1.
Author information
1
Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
2
Department of Clinical Immunology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
3
Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
4
Department of Heart Function Examination, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
5
Department of Pathophysiology, Hubei University of Medicine, Shiyan, China.
Abstract
AIM:
We aimed at investigating the effects of age on the predictive performances of non-invasive 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, 31-40, 41-50 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 gamma-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 the 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 31-40 years, 1.17 and 1.94 in 41-50 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 CHB patients. In particular, these scores performed poorly for identifying significant fibrosis in younger patients (≤30 years). This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
KEYWORDS:
age; aspartate aminotransferase to platelet ratio index; chronic hepatitis B; fibrosis score-4; gamma-glutamyl transpeptidase to platelet ratio; liver fibrosis