Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B

Table 4 The grading system based on the receiver operating characteristic curves of the non-invasive tests for predicting significant fibrosis, advanced fibrosis and cirrhosis in the different alanine aminotransferase groups

ALT groups	AUROC					Points	Grade
	≥ 0.8	0.750-0.800	0.700-0.750	0.650-0.70	< 0.65
ALT ≤ 40	GPR (≥ S3)	APRI (≥ S3)	APRI (≥ S2)	-	-	22	A
	APRI (S4)	FIB-4 (S4)	FIB-4 (≥ S2)
	King’s score (S4)	GPR (≥ S2)	FIB-4 (≥ S3)
		GPR (S4)	Forns index (≥ S2)
		King’s score (≥ S2)
		King’s score (≥ S3)
		Forns index (≥ S3)
		Forns index (S4)
40 < ALT ≤ 80	-	APRI (≥ S2)	FIB-4 (≥ S3)	FIB-4 (S4)	APRI (S4)	16.5	B
		APRI (≥ S3)	GPR (≥ S2)	King’s score (S4)
		FIB-4 (≥ S2)	GPR (≥ S3)
		King’s score (≥ S2)	GPR (S4)
		King’s score (≥ S3)	Forns index (S4)
		Forns index (≥ S2)
		Forns index (≥ S3)
ALT > 80	-	APRI (≥ S3)	APRI (≥ S2)	FIB-4 (≥ S2)	Forns index (≥ S2)	12.5	B
		King’s score (≥ S3)	APRI (S4)	FIB-4 (S4)
		FIB-4 (≥ S3)	GPR (≥ S3)	GPR (≥ S2)
			King’s score (S4)	GPR (S4)
			Forns index (≥ S3)	King’s score (≥ S2)
				Forns index (S4)

≥ 0.8: 2 points; 0.750-0.800: 1.5 points; 0.700-0.750: 1 point; 0.650-0.700: 0.5 points; < 0.65: 0 points; Grade A: 20-30 points; Grade B: 10-20 points; Grade C: 0-10 points. ALT: Alanine aminotransferase; S: Stage of fibrosis; GPR: Gamma-glutamyl transpeptidase (GGT)-to-platelet ratio; APRI: Aspartate aminotransferase (AST)-to-platelet (PLT) ratio index; FIB-4: Fibrosis index based on 4 factors; AUROC: Areas under the receiver operating characteristics curve.