Noninvasive diagnosis of significant liver inflammation in patients with chronic hepatitis B in the indeterminate phase.

ABSTRACT

The presence of significant liver inflammation is an important indication for antiviral treatment in patients with chronic hepatitis B (CHB) in the indeterminate phase. We aimed to establish a non-invasive nomogram to predict significant liver inflammation in these patients. A total of 195 CHB patients in the indeterminate phase were randomly split into training and validation sets. The least absolute shrinkage and selection operator and logistic regression were applied to identify risk factors and establish a predictive model. A calibration curve, decision curve analysis (DCA), and receiver operating characteristic (ROC) curve were applied to assess the performance of the nomogram. The median age was 42.0 y and 59.5% of the patients were male. Alkaline phosphatase, γ-glutamyl transpeptidase, and prothrombin time were independent predictors for significant liver inflammation and selected to establish the AGP-nomogram. The calibration plot demonstrated that the predicted results matched the actual values. The DCA showed a high net benefit when the threshold probability was 25-83% in the training set and 31-100% in the validation set. The areas under ROC curves of AGP-nomogram in predicting significant inflammation were significantly higher than ALT in the training set (0.744 vs. 0.642, P = 0.049) and validation set (0.766 vs. 0.660, P = 0.047). The ability of AGP-nomogram in predicting advanced inflammation was also superior to ALT. The AGP-nomogram can accurately identify significant inflammation in CHB patients in the indeterminate phase, and its application may reduce the need for liver biopsy and help identify candidates for antiviral treatment.Abbreviations AASLD American Association for the Study of Liver Diseases; ALB albumin; ALP alkaline phosphatase; ALT alanine aminotransferase; APRI aspartate aminotransferase-to-platelet ratio index; AST aspartate aminotransferase; AUROC area under the receiver operating characteristic curve; CHB chronic hepatitis B; CI confidence interval; DCA decision curve analysis; FIB-4 fibrosis index based on the four factors; GLB globulin; GGT γ-glutamyl transpeptidase; HBcAb hepatitis B core antibody; HBeAg hepatitis B e antigen; HBsAg hepatitis B surface antigen; HBV hepatitis B virus; HCC hepatocellular carcinoma; HIV human immunodeficiency virus; INR international-normalized ratio; IQR interquartile range; LASSO least absolute shrinkage and selection operator; LB liver biopsy; LR Likelihood ratio; NAFLD non-alcoholic fatty liver disease; NPV negative predictive value; PLT platelets; PPV positive predictive value; PT prothrombin time; ROC receiver operating characteristic; TB total bilirubin; TE transient elastography; ULN upper limit of normal.