J Viral Hepat. 2020 Mar 18. doi: 10.1111/jvh.13293. [Epub ahead of print]
Alanine Aminotransferase Influencing Performances of Routine Available Tests Detecting Hepatitis B Related Cirrhosis.
Chen YP1,2,3, Huang LW4, Lin XY1, Hu XM2, Liang XE1, Rong-Long J1,2.
Author information
1
Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
2
Hepatology Unit, Shenzhen Hospital, Southern Medical University, Shenzhen, 518110, China.
3
Department of Internal Medicine, Nanfang Hospital Taihe Branch, Guangzhou, 510540, China.
4
Department of Infectious Diseases, Shunde Hospital, Southern Medical University, Shunde, Guangdong, 528308, China.
Abstract
The performances of routine tests such as FIB-4 and APRI in detecting cirrhosis and significant fibrosis in chronic hepatitis B (CHB) have been shown to be discrepant between studies. Novel tests such as cell distribution width-platelet ratio (RPR), γ-glutamyl transpeptidase to platelet ratio (GPR) and easy liver fibrosis test (eLIFT) have also been introduced recently. To evaluate the aminotransferase influence on the performance of these routine tests, a total of 1005 CHB patients who underwent liver biopsies and routine tests were retrospectively analyzed. The diagnostic cutoffs referring to likelihood ratio were determined for excluding or including cirrhosis diagnosis, and also for ruling in significant fibrosis diagnosis. The performances ofRPR, FIB-4, eLIFT and APRI in detecting cirrhosis seemed improved at higher ALTlevels, whilst PR was conversely impaired. The likelihood ratios of APRI 2 in diagnosing cirrhosisatALT< 2 upper limit of normal (ULN), APRI 1.5 in determining significant fibrosisatALT ≤5ULN and-4 3.2 in diagnosing ≥Metavir F3 in the total cohort was∝, 14.6 and 20.6, respectively. The optimal cutoffs for cirrhosis diagnosis were increased with higher ALTs by tests which included aminotransferase level, but not for RPR. The proportions of patients classified as having cirrhosis or no cirrhosis stratified by ALT level cutoffs were superior. Stepwise applying RPR, GPR and eLIFT would determine 60% of patients as having cirrhosis or no cirrhosis with an accuracy of 93.0%. In conclusion, the performance of aminotransferase comprising tests in detecting cirrhosis in CHB were influenced by ALT levels. Thus ALT stratified cutoffs may be a preferred alternative. In resource-limited settings, stepwise applying routine tests could be recommended as a preferred measurement for cirrhosis detection.
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