1544
PREDICTIVE VALUE OF NON-INVASIVE METHODS LIVERFAST,
ACOUSTIC RADIATION FORCE IMPULSE (ARFI), FIB-4 AND
APRI TO IDENTIFY THE NATURAL PHASES OF CHRONIC
HEPATITIS B (CHB) INFECTION FROM THE NATIONAL
UNIVERSITY HOSPITAL (NUH) CHB STUDY COHORT OF
SINGAPORE
Seng Gee Lim1, Amy Tay1, Htet Htet Toe Wai Khine1, Janine
Marcos Dangbis1, Teresa Gonzalo2 and Ronald Quiambao2,
(1)Division of Gastroenterology and Hepatology, National
University Health System, Singapore, (2)Medical Affairs,
Fibronostics
Background: In order to determine the outcomes and
progression to significant liver fibrosis (SLF) as per ARFI,
we set up a prospective NUH HBV cohort with chronic HBV
infection (Ch.Inf) expected to have no/minimal liver disease
vs moderate/severe in chronic hepatitis (Ch.Hep) patients
(pts) (JHepatol2017) LIVERFAStTM (LF, Fibronostics, US),
is a patented technology to assess liver fibrosis(LF-F) and
activity(LF-A) Aim To estimate the negative predictive
value (NPV) and the discriminating value between Ch.Inf
and Ch.Hep with non-invasive tests LF-F, LF-A, ARFI, FIB-4
and APRI, in CHB pts from the NUH Singapore HBV cohort
Methods: Prospective naïve CHB pts aged >21yrs, with
ARFI<1.54m/s, were included. HBV phases were defined
on HBeAg presence, HBVDNA(VL, IU/mL) and ALT(IU/L):
Ch.Inf.HBe+[VL>107,ALT<40]; Ch.Hep.HBe+[VL104–
107,ALT>40]; Ch.Inf.HBe-[VL<2,000,ALT<40]; Ch.Hep.
HBe-[VL>2,000,ALT>40]; indeterminate (not all criteria)
and resolved HBV [HBsAg(-), VL<10,ALT<40,anti-HBc+]
Results: 724pts were included, [26 excluded (6 missing
data; 7 ARFI>1.54m/s; 13 LF not applicable)] with the main
characteristics [mean(se)] age 50(0 4)yrs, 51 7%males, 89 9%
HBeAg-, ALT 31(1)IU/l, VL 2,4x107(4643) IU/ml, qHBsAg
5428(758), ARFI 1.06(0,01). Prevalence of CHB profiles were:
60(8 3%) Ch.Hep.HBe-; 195(26 9%) Ch.Inf.HBe-; 33(4 6%)
Ch.Hep.HBe+; 24(3 3%) Ch.Inf.HBe+; 32(4 4%) HBsAg
nonReact and 380(52 5%) indeterminate (50 3%HBe-)
Spearman correlations of LF-Fib/LF-Act with ARFI, FIB-4 and
APRI were 0 18/0 21, 0 47/0 11 and 0 23/0 69, respectively (all
p<0 01) In HBeAg(-)pts, Ch.InfHBe- phase was discriminated
from Ch.HepHBe- as per liver disease estimators LF-Fib
(0 23vs0 28,p<0 05), LF-Act (0 07vs0 23,p<0 001) and APRI
(0 28vs0 44,p<0 001), respectively In HBeAg(+) pts, Ch.Inf
HBe+ phase was discriminated from Ch.HepHBe+ as per
LF-Fib (0 10vs0 19,p<0 001), LF-Act (0 09vs0 31,p<0 001),
and APRI (0 32vs0 46,p<0 001) ARFI and FIB-4 did not
discriminate Ch.Inf from Ch.Hep in both HBeAg+/-(p=NS)
NPV for LF-Fib/LF-Act/APRI were for HBe(-) 77%/82%/27%
and HBe(+) 89%/62%/12%, respectively Resolved HBV
had significantly lower activity than Ch.HepHBe- as per LFAct
(0 11vs 0 23, p<0 001) Among 6 pts (0 8%) that scored
F4 stage as per LF-Fib and F0 as per ARFI, 3 had false
positive LF-Fib Conclusion: LF-fib and LF-Act are reliable
tools for screening HBV infected patients and for detecting
phase-related liver disease, with better NPV than APRI or
FIB-4 Management of HBV pts could be improved by LF
tests. 作者: StephenW 时间: 2020-11-5 10:18