Since liver biopsy is invasive and Fibroscan has limited availability, various non-invasive blood parameters need evaluation to find the most useful parameter for detection of significant fibrosis in patients with chronic hepatitis B(CHB).Methods
In this retrospective study, records of patients who underwent liver biopsy for treatment naive CHB, were evaluated to obtain various non-invasive blood parameters (AST-platelet ratio index[APRI], Fibrosis-4[Fib-4], GGT-platelet ratio[GPR], GGT-to-albumin ratio[GAR]), in addition to Fibroscan, to detect significant fibrosis and compared these with fibrosis stage of liver biopsy.Results
A total of 125 were included (median age 34 [range 11–82] years, 74%males). Most (83%) patients were HBeAg negative. Liver biopsy revealed nil/mild fibrosis (Ishak <3) in 87% patients and significant fibrosis (Ishak ≥3) in 13% patients. Among non-invasive blood parameters, APRI and Fib-4 were available in 107 patients, GPR in 91, and GAR in 90. Fibroscan was available in 92 patients. All the blood parameters, as well as Fibroscan, were able to detect significant fibrosis significantly well (p<0.05). All parameters had PPV <35% but NPV above 92%. Fibroscan had the highest NPV (100%) at a cut-off <5.35 kPa, and among the blood parameters, GPR had highest NPV (95%) at a cut-off <0.444 (table 1).Conclusions
Non-invasive blood parameters (APRI, Fib-4, GPR, and GAR) with NPVs above 92% are excellent parameters for ruling-out significant fibrosis in patients with CHB. Among the blood parameter, GPR has the best NPV of 95% at a cut-off below 0.444 and should be used when Fibroscan is not available.