The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa  - Maud Lemoine1,2,
- Yusuke Shimakawa2,3,
- Shevanthi Nayagam1,
- Mustapha Khalil4,
- Penda Suso4,
- Jo Lloyd5,
- Robert Goldin5,
- Harr-Freeya Njai2,
- Gibril Ndow2,
- Makie Taal6,
- Graham Cooke7,
- Umberto D'Alessandro2,
- Muriel Vray3,
- Papa Saliou Mbaye8,
- Ramou Njie2,
- Vincent Mallet9,
- Mark Thursz1
- Author Affiliations - 1Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK
- 2The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia
- 3Emerging Disease Epidemilogy Unit, Institut Pasteur, Paris, France
- 4Department of Histopathology, Edward Francis Small Teaching Hospital, Banjul, The Gambia
- 5Centre for Pathology, Imperial College London, London, UK
- 6Ministry of Health and Social Welfare, Banjul, The Gambia
- 7Department of infectious disease, Imperial College London, St Mary's Hospital, London, UK
- 8Department of Hepatology and Gastroenterology, Principal Hospital, Dakar, Senegal
- 9Université Paris Descartes, APHP, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Paris, France
- Correspondence to Dr Maud Lemoine, Department of Hepatology, Imperial College London, St Mary's Hospital, London, W2 1NY, UK; [email protected]
- Received 30 January 2015
- Revised 3 April 2015
- Accepted 18 April 2015
- Published Online First 24 June 2015
Abstract Background Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa.
Methods Using liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets).
Results Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4.
Conclusions The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.
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发表于 2015-6-25 14:16