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Manea M, Mărunțelu I, Constantinescu I. A New Assessment of Two Transferase-Based Liver Enzymes in Low- and High-Fibrosis Patients Chronically Infected with Hepatitis B Virus: A Meta-Analysis and Pilot Study. J Clin Med 2024; 13:3903. [PMID: 38999469 PMCID: PMC11242663 DOI: 10.3390/jcm13133903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/23/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Background: The detection of fibrosis remains a necessity for the evaluation of hepatitis B virus (HBV)-infected patients, but the most accurate technique is invasive. Current studies aim to develop a novel noninvasive biomarker for fibrosis assessment, but no-one has found the ideal candidate. This study is a meta-analysis combined with a pilot study to investigate the connection between two transferase compounds and the levels of fibrosis. Methods: We studied data from PUBMED, Web of Science, and Scopus, retrieving 28,896 articles. Following PRISMA guidelines, we finally analyzed full-text articles written in English. The excluded items were duplicates, non-article entries, and irrelevant papers. We assessed the variations in alanine aminotransferase (ALT) and gamma-glutamyl transferase (GGT) levels between patients with high and low levels of fibrosis. Joanna Briggs Institute tools were used to assess article quality. We used R 4.2.2 for statistics. The pilot study included 14 randomly chosen patients with different fibrosis levels. Results: We found significant differences in ALT and GGT levels between patients with high and low fibrosis. The GGT/ALT ratio correlated with the levels of fibrosis and the fibrosis-4 (FIB-4) score. Conclusions: This meta-analysis assessed ALT and GGT levels in chronic HBV patients with fibrosis. The pilot study identified the first association between fibrosis and the GGT/ALT ratio in a Romanian cohort of chronic patients. This brings new ideas for future research.
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Affiliation(s)
- Marina Manea
- Immunology and Transplant Immunology, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
| | - Ion Mărunțelu
- Immunology and Transplant Immunology, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Ileana Constantinescu
- Immunology and Transplant Immunology, University of Medicine and Pharmacy "Carol Davila", 020021 Bucharest, Romania
- Centre of Immunogenetics and Virology, Fundeni Clinical Institute, 022328 Bucharest, Romania
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Ajuwon BI, Roper K, Richardson A, Lidbury BA. Routine blood test markers for predicting liver disease post HBV infection: precision pathology and pattern recognition. Diagnosis (Berl) 2023; 10:337-347. [PMID: 37725092 DOI: 10.1515/dx-2023-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/25/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Early stages of hepatitis B virus (HBV) infection usually involve inflammation of the liver. Patients with chronic infection have an increased risk of progressive liver fibrosis, cirrhosis, and life-threatening clinical complications of end-stage hepatocellular carcinoma (HCC). CONTENT Early diagnosis of hepatic fibrosis and timely clinical management are critical to controlling disease progression and decreasing the burden of end-stage liver cancer. Fibrosis staging, through its current gold standard, liver biopsy, improves patient outcomes, but the clinical procedure is invasive with unpleasant post-procedural complications. Routine blood test markers offer promising diagnostic potential for early detection of liver disease without biopsy. There is a plethora of candidate routine blood test markers that have gone through phases of biomarker validation and have shown great promise, but their current limitations include a predictive ability that is limited to only a few stages of fibrosis. However, the advent of machine learning, notably pattern recognition, presents an opportunity to refine blood-based non-invasive models of hepatic fibrosis in the future. SUMMARY In this review, we highlight the current landscape of routine blood-based non-invasive models of hepatic fibrosis, and appraise the potential application of machine learning (pattern recognition) algorithms to refining these models and optimising clinical predictions of HBV-associated liver disease. OUTLOOK Machine learning via pattern recognition algorithms takes data analytics to a new realm, and offers the opportunity for enhanced multi-marker fibrosis stage prediction using pathology profile that leverages information across patient routine blood tests.
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Affiliation(s)
- Busayo I Ajuwon
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
- Department of Microbiology, Faculty of Pure and Applied Sciences, Kwara State University, Malete, Nigeria
| | - Katrina Roper
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Alice Richardson
- Statistical Support Network, The Australian National University, Acton, Australian Capital Territory, Australia
| | - Brett A Lidbury
- National Centre for Epidemiology and Population Health, ANU College of Health and Medicine, The Australian National University, Acton, Australian Capital Territory, Australia
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Muacevic A, Adler JR, Kumar R, Dayal VM, Jha SK. Serum Gamma-Glutamyl Transpeptidase-to-Platelet Ratio as a Noninvasive Marker of Liver Fibrosis in Chronic Hepatitis B. Cureus 2023; 15:e33744. [PMID: 36793825 PMCID: PMC9925026 DOI: 10.7759/cureus.33744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/15/2023] Open
Abstract
Background The gamma-glutamyl transpeptidase (GGT)-to-platelet ratio (GPR) is identified as a new model for the assessment of liver fibrosis in patients with chronic hepatitis B (CHB). We aimed to determine the diagnostic performance of GPR for the prediction of liver fibrosis in patients with CHB. Methods In an observational cohort study, patients with CHB were enrolled. The diagnostic performance of GPR was compared with transient elastography (TE), aspartate aminotransferase-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) scores for the prediction of liver fibrosis using liver histology as a gold standard. Results Forty-eight patients with CHB with a mean age of 33.42 ± 15.72 years were enrolled. Liver histology showed meta-analysis of histological data in viral hepatitis (METAVIR) stage F0, F1, F2, F3, and F4 fibrosis in 11, 12, 11, seven, and seven patients, respectively. The Spearman correlation of METAVIR fibrosis stage with APRI, FIB-4, GPR, and TE were 0.354, 0.402, 0.551, and 0.726, respectively (P value < 0.05). TE had the highest sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (80%, 83%, 83%, and 79%, respectively), followed by GPR (76%, 65%, 70%, and 71%, respectively) for predicting significant fibrosis (≥F2). However, TE had comparable sensitivity, specificity, PPV, and NPV with GPR (86%, 82%, 42%, and 93%, and 86%, 71%, 42%, and 92%, respectively) for predicting extensive fibrosis (≥F3). Conclusion The performance of GPR is comparable to TE in predicting significant and extensive liver fibrosis. GPR may be an acceptable, low-cost alternative for predicting compensated advanced chronic liver disease (cACLD) (F3-F4) in CHB patients.
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Liu X, Zhou J, Zhu L, Zhang X, Li F. Diagnostic accuracy of apparent diffusion coefficient values combined with γ-glutamyl transpeptidase-to-platelet ratio parameters for predicting hepatitis B-related fibrosis. Clin Res Hepatol Gastroenterol 2022; 46:101968. [PMID: 35649482 DOI: 10.1016/j.clinre.2022.101968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/12/2022] [Accepted: 05/27/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The accuracy of non-invasive liver fibrosis diagnosis based on the apparent diffusion coefficient (ADC) value combined with the γ-glutamyl transpeptidase-to-platelet ratio (GPR) model to predict the stage of hepatitis B-related fibrosis has not been reported. This study aimed to evaluate the diagnostic efficacy of ADC value combined with GPR for liver fibrosis grading. METHODS The data of 180 patients with chronic hepatitis B (CHB) diagnosed by liver biopsy were analyzed. The ADC value, GPR, and their combination were assessed in different cirrhosis stages using receiver operating characteristic curve analysis to evaluate their value in diagnosing liver fibrosis. RESULTS We observed that liver fibrosis stages were inversely associated with ADC values (r=-0.691, P<0.001), and positively associated with GPR (r=0.502, P<0.001). The area under the curve for diagnostic efficacy of ADC values, GPR, and their combination for F≥2 liver fibrosis was 0.831, 0.749, and 0.858, respectively, and for F≥3 was 0.872, 0.771, and 0.903, respectively. The diagnostic cutoffs of the combination for each stage were -7.07, -12.21 and -37.75, respectively. CONCLUSIONS The combined diagnostic tool of ADC and GPR may improve the accuracy of hepatitis B-related liver fibrosis diagnosis, especially for F≥3.
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Affiliation(s)
- Xingxiang Liu
- Department of Laboratory Medicine, Huai'an Infectious Disease Hospital, Jiangsu, China
| | - Jian Zhou
- Department of Gastroenterology, Huai'an Hospital of Huai'an City, Jiangsu, China
| | - Liyao Zhu
- Department of Hepatology, Huai'an Infectious Disease Hospital, Jiangsu, China
| | - Xin Zhang
- Department of Medical Imaging, Huai'an Infectious Disease Hospital, Jiangsu, China.
| | - Feng Li
- Department of Medical Imaging, Huai'an Infectious Disease Hospital, Jiangsu, China.
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Diagnostic Value of FibroTouch and Non-invasive Fibrosis Indexes in Hepatic Fibrosis with Different Aetiologies. Dig Dis Sci 2022; 67:2627-2636. [PMID: 34059990 DOI: 10.1007/s10620-021-07049-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 05/09/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver biopsy is the gold standard for staging liver fibrosis, but it has numerous drawbacks, mainly associated with bleeding and bile fistula risks. A number of non-invasive techniques have been investigated, but they all have their own disadvantages. To avoid the risks mentioned above and to improve the diagnostic value, we still need to search for a more accurate non-invasive method to evaluate the degree of liver fibrosis. AIM This study aimed to evaluate the diagnostic performance of FibroTouch versus other non-invasive fibrosis indexes in hepatic fibrosis of different aetiologies. METHODS This study retrospectively enrolled 227 patients with chronic hepatic liver disease admitted to the first hospital of Lanzhou University from 2017 to 2020. Liver biopsy was performed in all of the patients, and their biochemical indicators were all tested. Non-invasive indexes including the fibrosis index based on four factors (FIB-4), the aminotransferase-to-platelet ratio index (APRI), and the gamma-glutamyl transpeptidase-to-platelet ratio index (GPRI) were all calculated. Transient elastography was performed using FibroTouch. RESULTS The correlation between FibroTouch and the pathology of liver fibrosis was significantly higher than that between the non-invasive fibrosis indexes and the biopsy results (r = 0.771, p < 0.05). The area under the receiver operating curve (AUC) of FibroTouch was significantly higher than that of FIB-4, APRI, and GPRI for the diagnosis of significant fibrosis (≥ S2 fibrosis stage), advanced fibrosis (≥ S3 fibrosis stage), and cirrhosis (= S4 fibrosis stage) (p < 0.05). The patients were grouped according to different aetiologies. The diagnostic value of FibroTouch had much higher credibility in different fibrosis stages for different causes compared with other non-invasive indexes. The AUC of FibroTouch showed both higher specificity and higher sensitivity than FIB-4, APRI, and GPRI for different liver fibrosis stages with different aetiologies. CONCLUSIONS FibroTouch demonstrates the highest diagnostic value for liver fibrosis and cirrhosis among non-invasive methods, showing better results than FIB-4, APRI, and GPRI, and surpassed only by liver biopsy. FibroTouch is reliable in assessing liver fibrosis with different aetiologies.
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Okdemir S, Cakmak E. A novel non-invasive score for the prediction of advanced fibrosis in patients with chronic hepatitis B. Ann Hepatol 2022; 27:100544. [PMID: 34571267 DOI: 10.1016/j.aohep.2021.100544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 04/05/2021] [Accepted: 04/17/2021] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Evaluation of liver fibrosis is important for treatment decisions, complications and to predict prognosis in patients with chronic hepatitis B (CHB). Our aim was to develop a new non-invasive fibrosis scoring method and prove its accuracy in the differentiation of no/low grade and advanced fibrosis in patients with CHB. PATIENTS AND METHODS Our study included 273 chronic hepatitis B patients who underwent liver biopsy from February, 2007 to February, 2019 with medical records retrospectively reviewed. Preparations of these patients were divided into two groups as ≤ 3 no-low grade fibrosis (n=236) and ≥ 4 advanced fibrosis (n=37) according to histological ISHAK fibrosis scoring system. RESULTS The newly developed AGAP score and other non-invasive fibrosis scores; Fibrosis-4 index, Aspartate aminotransferase to platelets ratio, Gamma glutamyl transpeptidase to platelet ratio, Goteborg University Cirrhosis Index, King's score, Albumin-bilirubin index, Fibrosis cirrhosis index, Fibrosis index, Fibrosis quotient, Lok score and mean and/or median values of Fibroindex were significantly higher in the advanced fibrosis group compared to the no/low grade fibrosis group (p<0.001). However, there was no significant difference in AAR score among the groups (p=0.265). With cut-off value of 4.038, AUROC value of 0.803, sensitivity of 75.7%, specificity of 73.7% and accuracy of 0.740, AGAP score showed the best performance in advanced fibrosis differentiation compared to 12 other non-invasive fibrosis scoring methods. CONCLUSIONS The newly developed AGAP score showed better performance in patients with CHB compared to 12 other non-invasive fibrosis scores in differentiation of no/low grade fibrosis and advanced fibrosis.
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Affiliation(s)
- Sannur Okdemir
- Department of Internal Medicine, Sarkikaraagac State Hospital, Isparta 32800, Turkey
| | - Erol Cakmak
- Department of Gastroenterology, Cumhuriyet University Faculty of Medicine, Sivas 58140, Turkey.
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Kayadibi H, Yilmaz B, Ozgur Yeniova A, Koseoglu H, Simsek Z. Development and evaluation of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis, and cirrhosis in patients with chronic hepatitis B infection. Eur J Gastroenterol Hepatol 2021; 33:e121-e130. [PMID: 33177385 DOI: 10.1097/meg.0000000000001973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Development of noninvasive liver fibrosis indexes has been research of interest due to the limitations of liver biopsy. Therefore, we aimed to develop and evaluate the diagnostic accuracy of a novel noninvasive index for predicting significant fibrosis, advanced fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) infection based on age and routine clinical laboratory tests. METHODS A total of 396 treatment naïve liver biopsy performed patients were divided into training (n = 262) and validation cohorts (n = 134). Histological staging was assessed by Ishak fibrosis scoring system. RESULTS In training cohort, we developed a novel fibrosis index, GAPI, using γ-glutamyl transpeptidase (GGT), age, platelet, and international normalized ratio (INR) results. The diagnostic accuracies of alanine aminotransferase ratio, age platelet index, aspartate aminotransferase to platelet ratio index, GGT to platelet ratio index, AST to lymphocyte ratio index, fibrosis index based on the four factors, Fibro Q, Goteborg University Cirrhosis Index, King's score, Pohl score, Wang I, fibrosis index, fibrosis cirrhosis index, cirrhosis discriminant score, Lok score, Doha score, Mehdi's model, GqHBsAg, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, RDW to lymphocyte ratio, RDW to platelet ratio, GGT/INR, GGT/albumin, white blood cell/platelet distribution width (PDW), mean platelet volume/PDW and platelet/PDW indexes were compared to GAPI index. For the prediction of significant fibrosis, advanced fibrosis and cirrhosis, the area under the receiver operating characteristic curves (AUROCs) of GAPI index were 0.776, 0.868, and 0.885 in training cohort, and 0.731, 0.883, and 0.919 in validation cohort, respectively. The AUROCs of the GAPI index were higher than those of the evaluated 27 noninvasive indexes to predict significant fibrosis, advanced fibrosis, and cirrhosis. CONCLUSION In resource limited settings, GAPI is a promising noninvasive liver fibrosis index for predicting significant fibrosis, advanced fibrosis and cirrhosis, and for decreasing the need for liver biopsy in patients with CHB infection using cutoff points of 2.00 and 3.50.
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Affiliation(s)
| | - Baris Yilmaz
- Department of Gastroenterology, Hitit University School of Medicine, Corum
| | - Abdullah Ozgur Yeniova
- Department of Gastroenterology, Tokat Gaziosmanpasa University School of Medicine, Tokat
| | - Huseyin Koseoglu
- Department of Gastroenterology, Hitit University School of Medicine, Corum
| | - Zahide Simsek
- Clinic of Gastroenterology, Diskapi Yildirim Beyazit Education and Research Hospital, Ankara
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Ding R, Lu W, Zhou X, Huang D, Wang Y, Li X, Yan L, Lin W, Song S, Zhang Z, Chen L. A Novel Non-invasive Model Based on GPR for the Prediction of Liver Fibrosis in Patients With Chronic Hepatitis B. Front Med (Lausanne) 2021; 8:727706. [PMID: 34631748 PMCID: PMC8495242 DOI: 10.3389/fmed.2021.727706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/30/2021] [Indexed: 12/07/2022] Open
Abstract
Background: Some controversy remains regarding conventional serum indices for the evaluation of liver fibrosis. Therefore, we aimed to combine the existing index with other serum parameters to discriminate liver fibrosis stages in patients with chronic hepatitis B (CHB). Methods: A total of 1,622 treatment-naïve CHB patients were divided into training (n = 1,211) and validation (n = 451) cohorts. Liver histology was assessed according to the Scheuer scoring scheme. All common demographic and clinical parameters were analyzed. Results: By utilizing the results of the logistic regression analysis, we developed a novel index, the product of GPR, international normalized ratio (INR), and type IV collagen (GIVPR), to discriminate liver fibrosis. In the training group, the areas under the ROCs (AUROCs) of GIVPR, APRI, FIB-4, and GPR for significant fibrosis were 0.81, 0.75, 0.72, and 0.77, respectively; the AUROCs of GIVPR, APRI, FIB-4, and GPR for advanced fibrosis were 0.82, 0.74, 0.74, and 0.78, respectively; and the AUROCs of GIVPR, APRI, FIB-4, and GPR for cirrhosis were 0.87, 0.78, 0.78, and 0.83, respectively. Similar results were also obtained in the validation group. Furthermore, the decision curve analysis suggested that GIVPR represented superior clinical benefits in both independent cohorts. Conclusion: The GIVPR constructed on GPR represents a superior predictive model for discriminating liver fibrosis in CHB patients.
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Affiliation(s)
- Rongrong Ding
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Lu
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xinlan Zhou
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Dan Huang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yanbing Wang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Xiufen Li
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Li Yan
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Weijia Lin
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Shu Song
- Department of Pathology, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Zhanqing Zhang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Liang Chen
- Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Lv D, Wang Z, Ji S, Wang X, Hou H. Plasma Levels of Homocysteine is Associated with Liver Fibrosis in Health Check-Up Population. Int J Gen Med 2021; 14:5175-5181. [PMID: 34512000 PMCID: PMC8423488 DOI: 10.2147/ijgm.s329863] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 08/24/2021] [Indexed: 01/02/2023] Open
Abstract
Object Studies have shown a link between homocysteine (Hcy) and heart diseases, kidney diseases, cerebrovascular diseases, liver diseases, and other pathological conditions. However, the relationship between Hcy and liver fibrosis (LF) is unclear. Here, we studied the link between plasma Hcy concentration and LF. Methods We determined and recorded the plasma Hcy concentration, general biochemical parameters, and liver stiffness measurement (LSM) in 1582 subjects, followed by statistical data analyses. Results During different stages of LF, we found a considerable difference (p <0.001 unless specified) in body mass index (BMI), sex, age, Hcy, the levels of alanine transaminase (ALT), gamma-glutamyl transpeptidase (GGT; P = 0.012), triglycerides (TG; P = 0.006), low-density lipoprotein cholesterol (LDL-C), fasting blood glucose (FBS), and platelet count (PLT). There was a strong association between the plasma Hcy concentration and the serum biomarkers of LF (P <0.001) and the values of LSM (P <0.001). Conclusion The plasma Hcy concentration was substantially different among different stages of LF. The higher the plasma Hcy concentration, the more evident was the degree of LF.
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Affiliation(s)
- Dan Lv
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Zepu Wang
- Department of Hepatobiliary Surgery, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Shuai Ji
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Xiaoxi Wang
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Huiqing Hou
- Physical Examination Center, Hebei General Hospital, Shijiazhuang City, Hebei Province, People's Republic of China
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Raadsen M, Du Toit J, Langerak T, van Bussel B, van Gorp E, Goeijenbier M. Thrombocytopenia in Virus Infections. J Clin Med 2021; 10:jcm10040877. [PMID: 33672766 PMCID: PMC7924611 DOI: 10.3390/jcm10040877] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 02/07/2023] Open
Abstract
Thrombocytopenia, which signifies a low platelet count usually below 150 × 109/L, is a common finding following or during many viral infections. In clinical medicine, mild thrombocytopenia, combined with lymphopenia in a patient with signs and symptoms of an infectious disease, raises the suspicion of a viral infection. This phenomenon is classically attributed to platelet consumption due to inflammation-induced coagulation, sequestration from the circulation by phagocytosis and hypersplenism, and impaired platelet production due to defective megakaryopoiesis or cytokine-induced myelosuppression. All these mechanisms, while plausible and supported by substantial evidence, regard platelets as passive bystanders during viral infection. However, platelets are increasingly recognized as active players in the (antiviral) immune response and have been shown to interact with cells of the innate and adaptive immune system as well as directly with viruses. These findings can be of interest both for understanding the pathogenesis of viral infectious diseases and predicting outcome. In this review, we will summarize and discuss the literature currently available on various mechanisms within the relationship between thrombocytopenia and virus infections.
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Affiliation(s)
- Matthijs Raadsen
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Justin Du Toit
- Department of Haematology, Wits University Donald Gordon Medical Centre Johannesburg, Johannesburg 2041, South Africa;
| | - Thomas Langerak
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
| | - Bas van Bussel
- Department of Intensive Care Medicine, Maastricht University Medical Center Plus, 6229 HX Maastricht, The Netherlands;
- Care and Public Health Research Institute (CAPHRI), Maastricht University, 6229 GT Maastricht, The Netherlands
| | - Eric van Gorp
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
| | - Marco Goeijenbier
- Department of Viroscience, Erasmus MC Rotterdam, Doctor molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (M.R.); (T.L.); (E.v.G.)
- Department of Internal Medicine, Erasmus MC Rotterdam, 3000 CA Rotterdam, The Netherlands
- Correspondence:
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Yang Z, Ma X, Zhou X, Huang D, Wang Y, Li X, Lu W, Zhang Z, Ding R. Predictive performance of eLIFT for liver inflammation and fibrosis in chronic liver diseases. Int J Med Sci 2021; 18:3599-3608. [PMID: 34522187 PMCID: PMC8436088 DOI: 10.7150/ijms.62386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/19/2021] [Indexed: 02/05/2023] Open
Abstract
Objective: The easy liver fibrosis test (eLIFT) is a novel predictor of liver fibrosis in chronic liver disease (CLD). This study aimed to evaluate the predictive value of the eLIFT for liver inflammation and fibrosis in CLD patients. Methods: We enrolled 1125 patients with CLD who underwent liver biopsy. The predictive accuracy for liver inflammation and fibrosis of the eLIFT was assessed and compared to that of the aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis-4 score (FIB-4), and gamma-glutamyl transpeptidase-to-platelet ratio (GPR) by ROC (Receiver Operating Characteristic) analysis and decision curve analysis (DCA). Results: The areas under the ROC curves (AUROCs) of the eLIFT for assessing liver inflammation G ≥ 2 and G ≥ 3 were 0.77 (0.75-0.80) and 0.81 (0.79-0.84), with cut-offs of 8.0 and 11.0, respectively. The AUROCs of the eLIFT for predicting fibrosis stages S ≥ 2 and S4 were 0.72 (0.70-0.76) and 0.76 (0.72-0.80), with cut-offs of 9.0 and 10.0, respectively. In discriminating G≥2 inflammation, the AUROC of the eLIFT was better than that of the FIB-4, with no difference compared with the GPR, but lower than that of the APRI. When discriminating G≥3 inflammation, the AUROC of the eLIFT was comparable to that of the APRI and GPR but superior to that of the FIB-4. There were no significant differences between the four indexes for predicting S≥2 and S4. Conclusion: The eLIFT is a potentially useful noninvasive predictor of liver inflammation and fibrosis in patients with CLD.
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Affiliation(s)
- Zongguo Yang
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xin Ma
- Department of Ultrasound, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xinlan Zhou
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Dan Huang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yanbing Wang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xiufen Li
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wei Lu
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zhanqing Zhang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- ✉ Corresponding authors: Zhanqing Zhang, MD, Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245; ; ORCID: https://orcid.org/0000-0001-7709-9027. Rongrong Ding, MD, Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245; ; ORCID: https://orcid.org/0000-0003-0581-9886
| | - Rongrong Ding
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- ✉ Corresponding authors: Zhanqing Zhang, MD, Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245; ; ORCID: https://orcid.org/0000-0001-7709-9027. Rongrong Ding, MD, Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245; ; ORCID: https://orcid.org/0000-0003-0581-9886
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Ding R, Zheng J, Huang D, Wang Y, Li X, Zhou X, Yan L, Lu W, Yang Z, Zhang Z. INR-to-platelet ratio (INPR) as a novel noninvasive index for predicting liver fibrosis in chronic hepatitis B. Int J Med Sci 2021; 18:1159-1166. [PMID: 33526976 PMCID: PMC7847629 DOI: 10.7150/ijms.51799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/18/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: We aimed to investigate whether a novel noninvasive index, i.e., the international normalized ratio-to-platelet ratio (INPR), was a variable in determining liver fibrosis stage in patients with chronic hepatitis B (CHB). Methods: A total of 543 treatment-naïve CHB patients were retrospectively enrolled. Liver histology was assessed according to the Metavir scoring scheme. All common demographic and clinical parameters were analyzed. Results: Based on routine clinical parameters (age, sex, HBeAg status, HBV DNA, hematological parameters, coagulation index, and liver biochemical indicators), a novel index, i.e., the INR-to-platelet ratio (INPR), was developed to magnify the unfavorable effects of liver fibrosis on INR and platelets. The AUCs of INPR for predicting significant fibrosis, advanced fibrosis, and cirrhosis were 0.74, 0.76 and 0.86, respectively. Compared with APRI, FIB-4, and GPR, the INPR had comparable predictive efficacy for significant fibrosis and better predictive performance for advanced fibrosis and cirrhosis. Conclusion: INPR could be an accurate, easily calculated and inexpensive index to assess liver fibrosis in patients with CHB. Further studies are needed to verify this indicator and compare it with other noninvasive methods for predicting liver fibrosis in CHB patients.
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Affiliation(s)
- Rongrong Ding
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Jianming Zheng
- Department of Infectious Diseases, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Dan Huang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Yanbing Wang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xiufen Li
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Xinlan Zhou
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Li Yan
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Wei Lu
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
| | - Zongguo Yang
- Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- ✉ Corresponding authors: Zongguo Yang, MD, PhD, Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel.: +8621-37990333 ext.3268; E-mail: ; ORCID: https://orcid.org/0000-0002-6623-4841; Zhanqing Zhang, MD, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245. E-mail: ; ORCID: https://orcid.org/0000-0001-7709-9027
| | - Zhanqing Zhang
- Department of Hepatobiliary Medicine, Shanghai Public Health Clinical Center, Fudan University, Shanghai 201508, China
- ✉ Corresponding authors: Zongguo Yang, MD, PhD, Department of Integrative Medicine, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel.: +8621-37990333 ext.3268; E-mail: ; ORCID: https://orcid.org/0000-0002-6623-4841; Zhanqing Zhang, MD, Shanghai Public Health Clinical Center, Fudan University, 2901 Caolang Road, Shanghai 201508, China. Tel: +8621-37990333 ext.3245. E-mail: ; ORCID: https://orcid.org/0000-0001-7709-9027
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Liu L, Al-Dhamin Z, Yuan X, Cui L, Yang Y, Zhao W, Zhang Y, Fu N, Nan Y. Plasma Golgi protein 73 levels predict prognosis of HCV-related hepatic fibrosis. Histol Histopathol 2020; 35:1309-1318. [PMID: 33063838 DOI: 10.14670/hh-18-269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To explore the correlation between plasma Golgi protein 73 (GP73) and progression of hepatitis C virus (HCV)-induced hepatic fibrosis. METHODS A total of 232 subjects of chronic hepatitis C and 31 healthy controls were enrolled from the Third Hospital of Hebei Medical University from January 2010 to September 2018. The plasma GP73 levels were detected by ELISA. Liver tissue sections stained with hematoxylin and eosin and Masson-trichrome were examined under a light microscope based on the METAVIR scoring system and "Beijing classification (P-I-R)". The correlation analysis and receiver operating characteristic (ROC) curve were performed to analyze the diagnostic efficiency of plasma GP73, APRI, and FIB-4 for staging hepatic fibrosis and predicting the disease progression. RESULTS The plasma GP73 levels were increased with the progression of liver fibrosis, and GP73 concentrations in healthy controls, HCV patients with fibrosis stage 1, 2, 3 and 4 were 94.82, 151.3, 157.9, 181.7 and 208.5 ng/ml, respectively. According to "Beijing classification", There was a statistically significant difference in plasma GP73 concentrations between patients in the progression and regressive / indeterminate group (177.08 vs 154.00 ng/ml , P = 0.007).The area under the ROC curves (AUCs) of GP73, APRI, and FIB-4 for diagnosis of liver cirrhosis were 0.89, 0.77, and 0.82, respectively, and GP73 for progressive fibrosis was 0.73. The plasma GP73 levels were significantly positively correlated with hepatic inflammation, serum ALT, and negatively correlated with albumin levels. CONCLUSION The plasma GP73 might be a potential biomarker for staging liver fibrosis, and could predict regression or progression of HCV-related liver fibrosis.
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Affiliation(s)
- Lingdi Liu
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Zaid Al-Dhamin
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Xiwei Yuan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Luyao Cui
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Yang Yang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Wen Zhao
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Ying Zhang
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Na Fu
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China
| | - Yuemin Nan
- Department of Traditional and Western Medical Hepatology, Third Hospital of Hebei Medical University and Hebei Key Laboratory of Mechanism of Liver Fibrosis in Chronic Liver Disease, Shijiazhuang, China.
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Review of Serum Biomarkers and Models Derived from Them in HBV-Related Liver Diseases. DISEASE MARKERS 2020; 2020:2471252. [PMID: 32774512 PMCID: PMC7391085 DOI: 10.1155/2020/2471252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 07/11/2020] [Indexed: 12/13/2022]
Abstract
A series of predictive scoring systems is available for stratifying the severity of conditions and assessing the prognosis in patients with HBV-related liver diseases. We show nine of the most popular serum biomarkers and their models (i.e., serum cystatin C, homocysteine, C-reactive protein, C-reactive protein to albumin ratio, aspartate aminotransferase to platelet ratio index, fibrosis index based on four factors, gamma-glutamyl transpeptidase to platelet ratio, albumin-bilirubin score, and gamma-glutamyl transpeptidase to albumin ratio) that have gained great interest from clinicians. Compared with traditional scoring systems, these serum biomarkers and their models are easily acquired, simple, and relatively inexpensive. In the present review, we summarize the latest studies focused on these serum biomarkers and their models as diagnostic and prognostic indexes in HBV-related liver diseases.
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15
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King’s Fibrosis, Fibrosis Index, GPR, and ALBI Score Are Useful Models for Liver Fibrosis in Chronic Hepatitis B Patients Pre- and Post-Treatment. HEPATITIS MONTHLY 2019. [DOI: 10.5812/hepatmon.96081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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16
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Lu W, Zhang YP, Zhu HG, Zhang T, Zhang L, Gao N, Chang DY, Yin J, Zhou XY, Li MY, Li YT, Li ZZ, He Q, Geng Y. Evaluation and comparison of the diagnostic performance of routine blood tests in predicting liver fibrosis in chronic hepatitis B infection. Br J Biomed Sci 2019; 76:137-142. [PMID: 31062646 DOI: 10.1080/09674845.2019.1615717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background & aims: Biopsy is the gold standard for staging liver fibrosis, but it may be accompanied by complications. As an alternative, non-invasive markers such as transient elastography (for liver fibrosis) and certain combinations of routine blood markers (liver function tests, full blood count) have been developed although their clinical significance remains controversial. Here, we compare the diagnostic values of non-invasive markers for liver fibrosis in patients with chronic hepatitis B infection. Methods: Transient elastography and routine laboratory tests were performed in 196 patients. Diagnostic performances were compared and were assessed based on the area under the curve (AUC) of a receiver operating characteristic (ROC) analysis. Results: Elevated GGT to platelet ratio (GPR), the fibrosis index FIB-4 [based on age, AST, platelets and ALT], platelet to lymphocyte ratio (PLR) and total bilirubin were independent predictors of liver stiffness defined by transient elastography (all P < 0.001). The AUCs of GPR in predicting both advanced fibrosis and cirrhosis were significantly larger than that of FIB-4 (P = 0.037 and P = 0.008, respectively) and AST-to-platelet ratio index (APRI) (P = 0.008 and P = 0.005). FIB-4, APRI and red cell volume distribution width-to-platelet ratio (RPR) had similar diagnostic values in discriminating different levels of liver fibrosis. Conclusions: GPR showed the best diagnostic value and RPR and PLR are easily available and inexpensive markers in evaluating fibrosis and cirrhosis. The diagnostic values of these laboratory markers are useful in diagnosing advanced fibrosis or cirrhosis, and in confirming the different levels of liver fibrosis.
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Affiliation(s)
- W Lu
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - Y P Zhang
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - H G Zhu
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - T Zhang
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - L Zhang
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - N Gao
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - D Y Chang
- b Department of Gastroenterology and Hepatology , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - J Yin
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - X Y Zhou
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - M Y Li
- c Department of Microbiology and Infectious Disease Center , Peking University Health Science Center , Beijing , China
| | - Y T Li
- d Key Laboratory of Medical Molecular Virology of Ministries of Health and Education, Shanghai Medical College , Fudan University , Shanghai , China
| | - Z Z Li
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - Q He
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
| | - Y Geng
- a Department of Laboratory , the Second Affiliated Hospital of Xi'an Jiao Tong University , Xi'an , China
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17
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Zhao LY, Yang DD, Ma XK, Liu MM, Wu DH, Zhang XP, Ruan DY, Lin JX, Wen JY, Chen J, Lin Q, Dong M, Qi JJ, Hu PS, Zeng ZL, Chen ZH, Wu XY. The Prognostic Value of aspartate aminotransferase to lymphocyte ratio and systemic immune-inflammation index for Overall Survival of Hepatocellular Carcinoma Patients Treated with palliative Treatments. J Cancer 2019; 10:2299-2311. [PMID: 31258733 PMCID: PMC6584423 DOI: 10.7150/jca.30663] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 03/07/2019] [Indexed: 02/06/2023] Open
Abstract
Background: Lymphocytes were reported to play a significant part in host anticancer immune responses and influence tumour prognosis. Few studies have focused on the prognostic values of aspartate aminotransferase (AST) to lymphocyte ratio (ALRI), aspartate aminotransferase to platelet count ratio index (APRI) and systemic immune-inflammation index (SII) in hepatocellular carcinoma (HCC) treated with palliative treatments. Methods: Five hundred and ninety-eight HCC patients treated with palliative therapies were retrospectively analysed. We randomly assigned patients into the training cohort (429 patients) and the validation cohort I (169 patients). Receiver operating characteristic (ROC) curves were used to identify the best cut-off values for the ALRI, APRI and SII in the training cohort and the values were further validated in the validation cohort I. Correlations between ALRI and other clinicopathological factors were also analysed. A prognostic nomogram including ALRI was established. We validated the prognostic value of the ALRI, SII and APRI with two independent cohorts, the validation cohort II of 82 HCC patients treated with TACE and the validation cohort III of 150 HCC patients treated with curative resection. In the training cohort and all the validation cohorts, univariate analyses by the method of Kaplan-Meier and multivariate analysis by Cox proportional hazards regression model were carried out to identify the independent prognostic factors. Results: The threshold values of ALRI, APRI and SII were 86.3, 1.37 and 376.4 respectively identified by ROC curve analysis in the training cohort. Correlation analysis showed that ALRI>86.3 was greatly associated with higher rates of Child-Pugh B&C, portal vein tumor thrombosis (PVTT) and ascites (P < 0.05). Correspondingly, ALRI level of HCC patients with Child-Pugh B&C, PVTT and ascites was evidently higher than that of HCC patients with Child-Pugh A, without PVTT and without ascites (P < 0.001). In the training cohort and the validation cohort I, II, III, the OS of patients with ALRI >86.3 was obviously shorter than patients with ALRI ≤86.3 (P <0.001). We identified ALRI as an independent prognostic factor by univariate and multivariate analyses both in training Cohort (HR=1.481, P=0.004), validation cohort I (HR=1.511, P=0.032), validation cohort II (HR=3.166, P=0.005) and validation cohort III (HR=3.921, P=0.010). The SII was identified as an independent prognostic factor in training cohort (HR=1.356, P=0.020) and the validation cohort II (HR=2.678, P=0.002). The prognostic nomogram including ALRI was the best in predicting 3-month, 6-month, 1-year, 2-year survival And OS among TNM, ALRI, ALRI-TNM and nomogram. Conclusions: The ALRI was a novel independent prognostic index for the HCC patients treated with palliative treatments.
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Affiliation(s)
- Li-Yun Zhao
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Dong-Dong Yang
- Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, China
| | - Xiao-Kun Ma
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Meng-Meng Liu
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Dong-Hao Wu
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Xiao-Ping Zhang
- Meihua Street Community Health Service Center, Yuexiu District Guangzhou, 510000, China
| | - Dan-Yun Ruan
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jin-Xiang Lin
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jing-Yun Wen
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jie Chen
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Qu Lin
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Min Dong
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
| | - Jing-Jing Qi
- Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, China
| | - Pei-Shan Hu
- Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, China
| | - Zhao-Lei Zeng
- Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, China
| | - Zhan-Hong Chen
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China.,Department of Medical Oncology of Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfengdong Road, Guangzhou, 510060, China
| | - Xiang-Yuan Wu
- Department of Medical Oncology and Guangdong Key Laboratory of Liver Disease, Third Affiliated Hospital of Sun Yat-sen University, 600 Tianhe Road, Guangzhou, 510630, China
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Diagnostic accuracy of γ-glutamyl transpeptidase-to-platelet ratio for predicting hepatitis B-related fibrosis: a meta-analysis. Eur J Gastroenterol Hepatol 2019; 31:599-606. [PMID: 30807447 DOI: 10.1097/meg.0000000000001381] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Emerging published data on the accuracy of γ-glutamyl transpeptidase-to-platelet ratio (GPR) for diagnosing hepatitis B virus (HBV)-related fibrosis are inconsistent. The aim of this study was to systematically review the performance of GPR for diagnosing HBV-related significant fibrosis, severe fibrosis, and cirrhosis. PATIENTS AND METHODS A comprehensive literature search of PubMed, Web of Science, and EMBASE was conducted before July 2018. Study selection was performed according to inclusion and exclusion criteria. The relevant parameters of eligible studies were abstracted. The methodological quality was assessed according to the Quality Assessment of Diagnostic Accuracy Studies. Areas under summary receiver operating characteristic curves, sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratios were used to examine the GPR accuracy for the diagnosis of significant fibrosis, severe fibrosis, and cirrhosis. RESULTS A total of 10 studies including 5882 patients with HBV infection underwent liver biopsy were incorporated. The prevalence of significant fibrosis, severe fibrosis, and cirrhosis were 58% (range: 22-72%), 36% (range: 10-55%), and 19% (range: 2-33%), respectively. Areas under summary receiver operating characteristic curves of GPR for predicting significant fibrosis, severe fibrosis, and cirrhosis were 0.733, 0.777, and 0.796, respectively. Subgroup analysis was performed according to geographical region and histological scoring system with similar results. CONCLUSION GPR has moderate diagnostic accuracy for predicting HBV-related significant fibrosis, severe fibrosis, and cirrhosis, and further studies with large sample size, rigorous design, multicenter study population are urgently needed.
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Ji SS, Jiang HD, Jiang JC, Li J, Lin ST, Chen B, Xu SH. Applicability of liver stiffness measurement based nomograms to the assessments of hepatitis B related significant fibrosis and cirrhosis. Clin Chim Acta 2018; 489:75-82. [PMID: 30471249 DOI: 10.1016/j.cca.2018.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 11/07/2018] [Accepted: 11/20/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND We evaluated liver fibrosis in patients with chronic hepatitis B (CHB) and mildly raised alanine transaminase (ALT) activities between 1-2 times the upper limit of normal (ULN) which was near the threshold for initiating treatment. METHODS Nomogram-Fibrosis and Nomogram-Cirrhosis were elaborated with variables independently associated with significant fibrosis and cirrhosis determined by multivariate logistic regression. Calibration, receiver operator characteristic (ROC) and decision curves were applied to comparing nomograms with aspartate aminotransferase (AST) to platelet count (PLT) ratio index (APRI), age-AST-PLT-ALT index (FIB-4) and liver stiffness measurement (LSM). RESULTS The Nomogram-Fibrosis was constructed with LSM, PLT, and gamma-glutamyl transpeptidase (GGT). Nomogram-Cirrhosis contained one more variable of age other than Nomogram-Fibrosis. The calibration demonstrated that the assessments of significant fibrosis or cirrhosis by nomograms were in line with liver biopsy. The AUROC of Nomogram-Fibrosis was 0.788, lager than APRI (0.586), FIB-4 (0.656) and LSM (0.735). The AUROC of Nomogram-Cirrhosis was 0.889, larger than APRI (0.642), FIB-4 (0.725) and LSM (0.837). Furthermore, the decision curve analysis suggested the most net benefits were provided by the nomograms. CONCLUSIONS Nomogram-Fibrosis and Nomogram-Cirrhosis could be promising tools for recognizing significant fibrosis and cirrhosis for CHB patients with mild raised ALT activities.
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Affiliation(s)
- Si-Si Ji
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China
| | - Hai-Dan Jiang
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China
| | - Jia-Chun Jiang
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China
| | - Jia Li
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China
| | - Shu-Ting Lin
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China
| | - Bin Chen
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China.
| | - Shi-Hao Xu
- Department of Ultrasonography, the First Affiliated Hospital of Wenzhou Medical University, China.
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Ouyang GX, Zhang YM, Zhu SL, Wang P, Ren Y, Li JH, Liu YK, Chen J, Xiang BD, Li LQ, Liu JY, Zhang ZM. A novel, non-invasive model for diagnosing liver fibrosis stage in patients with hepatocellular carcinoma. Sci Rep 2018; 8:13074. [PMID: 30166568 PMCID: PMC6117345 DOI: 10.1038/s41598-018-31351-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 08/16/2018] [Indexed: 02/08/2023] Open
Abstract
The aim of this study was to investigate the diagnostic value of the platelet count-to-spleen volume ratio (PSR) for diagnosing hepatic fibrosis in patients with hepatocellular carcinoma (HCC). In this interim analysis of an on-going prospective study, 117 patients with HCC and with or without cirrhosis or fibrosis in different stages were analyzed. Fibrosis staging negatively correlated with PSR and the liver volume-to-spleen volume ratio (LSR), while it positively correlated with aspartate aminotransferase-to-platelet ratio index (APRI), Frons' index, S-index and a fibrosis index based on four factors (FIB-4). The area under the receiver operating characteristic curve (AUROC) was significantly larger for PSR (0.777) than LSR (0.633, P = 0.002). Among patients with significant fibrosis, AUROC for PSR did not differ significantly from the AUROCs for APRI (0.789, P = 0.825), Frons' index (0.674, P = 0.102), FIB-4 (0.704, P = 0.251) or S-index (0.696, P = 0.204). Among patients with severe fibrosis, AUROC was significantly higher for PSR (0.808) than for LSR (0.685, P = 0.003), Frons' index (0.673, P = 0.014), FIB-4 (0.684, P = 0.029), or S-index (0.672, P = 0.016); in contrast, the AUROC for PSR was not significantly different from that for APRI (0.739, P = 0.215). Among patients with cirrhosis, AUROC was significantly higher for PSR (0.814) than for LSR (0.671, P = 0.001) or S-index (0.679, P = 0.022), while the AUROC for PSR did not differ significantly from those for APRI (0.711, P = 0.105), Frons' index (0.722, P = 0.061) or FIB-4 (0.708, P = 0.079). Our results suggest that PSR may be a useful non-invasive model for diagnosing liver fibrosis stage in patients with HCC in China.
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Affiliation(s)
- Gao-Xiong Ouyang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yu-Mei Zhang
- Department of Chemotherapy, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Shao-Liang Zhu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Peng Wang
- Department of Radiology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yuan Ren
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jia-Hao Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Yu-Kai Liu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jun Chen
- Department of Pathology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Bang-De Xiang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Le-Qun Li
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China
| | - Jian-Yong Liu
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China.
| | - Zhi-Ming Zhang
- Department of Hepatobiliary Surgery, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China.
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Ke MY, Zhang M, Su Q, Wei S, Zhang J, Wang Y, Wu R, Lv Y. Gamma-glutamyl transpeptidase to platelet ratio predicts short-term outcomes in hepatocellular carcinoma patients undergoing minor liver resection. J Surg Res 2018; 231:403-410. [PMID: 30278960 DOI: 10.1016/j.jss.2018.05.049] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/22/2018] [Accepted: 05/24/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is a strong correlation between liver fibrosis and postoperative morbidity after hepatectomy in hepatocellular carcinoma (HCC) patients. The aim of this study was to evaluate which noninvasive fibrosis index (gamma-glutamyl transpeptidase to platelet ratio [GPR], aspartate aminotransferase to platelet ratio index, fibrosis-4 index, or Forns index) was best able to predict complications in patients undergoing hepatectomy for HCC. MATERIALS AND METHODS This retrospective analysis included 275 patients who underwent hepatectomy for HCC from January 2008 to December 2012. Postoperative mortality was defined as death within 90 d after surgery. Complications were grouped into seven grades on the basis of the modified Clavien classification, and major postoperative complications were defined as grade 3 or above. The influence of noninvasive fibrosis indices on postoperative outcomes was assessed by receiver operating characteristic analysis. The primary outcomes were overall complications and major complications, estimated by univariate and multivariate analysis. RESULTS Patients with HCC undergoing anatomical liver resection in the authors' department were evaluated for this study. Finally, 275 patients who underwent minor liver resection (≤2 liver segments) were included. Of these, 231 (84%) were male. The multivariate analysis indicated that the GPR index was not only independently associated with overall complications (hazard ratio, 2.692; 95% confidence interval [CI], 1.626-4.250; P < 0.001) but also independently predictive of major complications (hazard ratio, 1.143; 95% CI, 1.046-1.249; P = 0.03). The areas under the receiver operating characteristic curve for predicting overall complications and major complications for the GPR index were 0.704 (95% CI, 0.643-0.765; P < 0.001) and 0.752 (95% CI, 0.638-0.865; P < 0.001), respectively. CONCLUSIONS The data suggested that the GPR index could be a promising predictor of overall postoperative complications and major complications after minor hepatectomy for HCC.
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Affiliation(s)
- Meng-Yun Ke
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Mei Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Qing Su
- Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Shasha Wei
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Jia Zhang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Yue Wang
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China
| | - Rongqian Wu
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China.
| | - Yi Lv
- Shaanxi Provincial Center for Regenerative Medicine and Surgical Engineering, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; National Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Institute of Advanced Surgical Technology and Engineering, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China; Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi'an Jiaotong University, Xi'an City, Shaanxi Province, China.
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Gamma-Glutamyl Transpeptidase-to-Platelet Ratio Predicts Significant Liver Fibrosis of Chronic Hepatitis B Patients in China. Gastroenterol Res Pract 2017; 2017:7089702. [PMID: 28831282 PMCID: PMC5555020 DOI: 10.1155/2017/7089702] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 03/15/2017] [Accepted: 05/22/2017] [Indexed: 12/17/2022] Open
Abstract
Background and Aims We want to investigate whether a novel noninvasive marker is suitable for Chinese CHB patients. Methods A total of 160 treatment-naïve CHB patients who underwent liver biopsy were enrolled in our study, and we assessed the diagnostic accuracies of GPR, aspartate transaminase-to-platelet ratio index (APRI), and the fibrosis index based on 4 factors (FIB-4) in them. Results Of these 160 CHB patients, the numbers of F0, F1, F2, F3, and F4 are 34 (21.3%), 62 (38.8%), 18 (11.3%), 24 (15%), and 22 (13.8%), respectively. The area under the receiver operating characteristic curves (AUROC) of GPR for fibrosis (0.77 versus 0.70, P = 0.03), significant fibrosis (0.70 versus 0.63, P = 0.02), and extensive fibrosis (0.71 versus 0.64, P = 0.02) were significantly higher than those of APRI. The AUROCs of GPR and Fib-4 for fibrosis (0.77 versus 0.75, P = 0.14), significant fibrosis (0.70 versus 0.70, P = 0.22), extensive fibrosis (0.71 versus 0.68, P = 0.13), and cirrhosis (0.64 versus 0.67, P = 0.24) were comparable. Conclusions The GPR can be a routine laboratory marker to stage liver fibrosis in patients with CHB in China.
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