Value of gamma-glutamyl transpeptidase/albumin ratio in the noninvasive diagnosis of liver fibrosis in patients with chronic hepatitis B virus infection / 临床肝胆病杂志

ABSTRACT

ObjectiveTo investigate the value of gamma-glutamyl transpeptidase (GGT)/albumin (Alb) ratio in the noninvasive diagnosis of liver fibrosis degree in patients with chronic hepatitis B virus (HBV) infection. MethodsA retrospective analysis was performed for the clinical data of 322 patients with chronic HBV infection who underwent liver biopsy in Chaohu Hospital of Anhui Medical University from January 2018 to March 2020, and according to liver fibrosis degree based on liver biopsy, the 322 patients were divided into S0-S1 group with 183 patients, S2 group with 68 patients, S3 group with 35 patients, and S4 group with 36 patients. The clinical indices of routine blood test, virology, and blood biochemistry were collected. A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups, and the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data. A Spearman rank correlation analysis was used to investigate the correlation of the three noninvasive models GGT/Alb ratio, aspartate aminotransferase-to-platelet ratio index (APRI) score, and fibrosis-4 (FIB-4) index with liver fibrosis degree. A receiver operating characteristic (ROC) curve was plotted for GGT/Alb ratio to evaluate its diagnostic value. ResultsWith the aggravation of liver fibrosis degree, there were gradual reductions in Alb (F=7351, P＜0.05), HBV DNA (χ2=2.820, P＜0.05), and platelet count (F=6.182, P＜0.05) and gradual increases in age (χ2=3145, P＜0.05), GGT (χ2=6.149, P＜0.05), GGT/Alb ratio (χ2=7.064, P＜0.05), APRI score (χ2=9.022, P＜0.05), and FIB-4 index (χ2=8.254, P＜0.05). The Spearman rank correlation analysis showed that GGT/Alb ratio was positively correlated with liver fibrosis stage (r=0.396, P＜0.01), with a significantly higher correlation coefficient than APRI score (r=0.327, P＜0.001) and FIB-4 index (r=0.370, P＜0.001). The ROC curve analysis showed that in the patients with significant liver fibrosis, severe liver fibrosis, and liver cirrhosis, GGT/Alb ratio had similar areas under the ROC curve to APRI score and FIB-4 index (0.680/0.676/0.695 vs 0692/0.698/0.728 and 0.659/0.661/0.684, all P＞0.05). At the optimal cut-off values of 0.435, 0.465, 0.465, respectively, GGT/Alb ratio had sensitivities of 69.1%, 66.2%, and 69.0%, respectively, and specificities of 65.4%, 65.9%, and 67.0%, respectively, in the diagnosis of significant liver fibrosis, severe liver fibrosis, and liver cirrhosis. ConclusionLike APRI score and FIB-4 index, GGT/Alb ratio is a simple and practical noninvasive model for the diagnosis of liver fibrosis and can provide a reference for the diagnosis of liver fibrosis degree in patients with chronic HBV infection.