RESUMEN
Background/aim: Liver biopsy, traditionally considered to be the reference standard for staging fibrosis, has been challenged over the past decade by the development of noninvasive methodologies. Noninvasive methods, initially studied and validated in patients with chronic hepatitis C, are now used increasingly for patients with hepatitis B. However, the usefulness of these markers in the prediction of liver fibrosis in HBeAg negative patients with normal enzymes still needs to be validated
Patients and methods: Patients with chronic hepatitis B attending the National Liver Institute Biopsy Unit from September 2010 to September 2013 were included in the present study. For patients with persistently normal alanine aminotransferase greater than 40 [69 patients], the following indirect biochemical indices were measured and compared with the biopsy result: aspartate aminotransferase to alanine aminotransferase ratio [AAR], fibrosis index based on the four factors, aspartate aminotransferase to platelet ratio index, AAR to platelet ratio index, fibroindex, and age-platelet index [API]
Results: A total of 50 patients suffered from nonsignificant fibrosis [METAVIR F0-F1] and 19 patients suffered from significant fibrosis. gamma-Globulin [P=0.001] and gamma-glutamyl transferase [P=0.007] were independent predictors of fibrosis. Analysis with receiver operating curve showed that none of the predictors had a powerful diagnostic value. API had the best sensitivity and specificity [sensitivity: 83%; specificity: 58%] for predicting liver fibrosis, followed by fibroindex [sensitivity: 75%; specificity: 54%]. Aspartate aminotransferase to platelet ratio index showed a low precision in identifying significant fibrosis, with an area under the curve of 0.6
Conclusion: None of the tested noninvasive indices could distinguish the significant liver fibrosis effectively. We suggest the use of platelets, gamma-glutamyl transferase and gamma-globulins, API, and fibroindex for monitoring disease severity and predicting prognosis. In suspicious cases, a more validated modality such as FibroScan can be performed