Staging of liver fibrosis in chronic hepatitis B patients with a composite predictive model: A comparative study

Table 1 Main characteristics of patients studied

	Patients (n = 78)	F0F1 (n = 46)	F2F3F4 (n = 32)	P value (F0F1 vs F2F3F4)
Age (mean ± SD, yr)	32.6 ± 12.3	29.6 ± 12.0	36.9 ± 11.4	0.009
Men (n, %)	66 (84.6)	38 (82.6)	28 (87.5)	0.113
CHB family history (n, %)	29 (37.2)	18 (39.1)	11 (34.4)	0.104
WBC (mean ± SD, 109/L)	5.3 ± 1.4	5.5 ± 1.2	4.9 ± 1.6	0.060
Hb (mean ± SD, g/L)	142.6 ± 15.7	145.6 ± 13.4	138.3 ± 17.8	0.044
PLT (mean ± SD, 109/L)	170.2 ± 51.5	185.9 ± 40.7	147.6 ± 57.3	0.002
TB [median (interquartile range), μmol/L]	15.4 (11.5-20.6)	14.7 (10.6-19.1)	16.7 (12.1-24.1)	0.087
CB [median (interquartile range), μmol/L]	5.7 (4.0-7.8)	5.5 (3.9-7.1)	6.4 (4.5-10)	0.057
ALT [interquartile median (range), U/L]	115 (55-241)	93.5 (32-240)	132 (76-263)	0.165
AST [interquartile median (range), U/L]	67.5 (38-121)	56 (30-95)	86.5 (41-152)	0.042
GGT [interquartile median (range), U/L]	52.5 (27-76)	36.5 (21-59)	66.5 (46-94)	0.006
Alb (mean ± SD, g/L)	42.4 ± 5.1	44.0 ± 4.8	40.2 ± 4.6	0.001
PT (mean ± SD, s)	12.0 ± 1.1	11.5 ± 0.9	12.6 ± 0.9	< 0.001
PI (mean ± SD, s)	1.00 ± 0.08	1.03 ± 0.07	0.95 ± 0.06	< 0.001
TC (mean ± SD, mmol/L)	3.8 ± 0.8	3.8 ± 0.8	3.7 ± 0.9	0.135
HA [interquartile median (range), ng/mL]	125 (75-224)	88 (49-129)	167 (116-382)	< 0.001
A2M (mean ± SD, g/L)	2.96 ± 0.58	2.73 ± 0.48	3.28 ± 0.55	< 0.001
Lg HBV-DNA (mean ± SD)	6.0 ± 1.9	5.9 ± 2.0	6.1 ± 2.1	0.314
HBeAg positive (n, %)	55 (70.5)	32 (69.6)	23 (71.9)	0.223
Liver specimen length (mean ± SD, mm)	18.2 ± 3.4	18.4 ± 3.3	17.9 ± 3.6	0.254
METAVIR A stage (n, %)
A0	4 (5.1)
A1	41 (52.5)
A2	32 (41.1)
A3	1 (1.3)
METAVIR F stage (n, %)
F0	13 (16.7)
F1	33 (42.3)
F2	13 (16.7)
F3	10 (12.8)
F4	9 (11.5)

SD: Standard deviation; WBC: Leucocyte; Hb: Hemoglobin; TB: Total bilirubin; CB: Conjugated bilirubin; Alb: Albumin; TC: Total cholesterol.

Table 2 AUROC for F0F1 vs F2-4 and F0-2 vs F3-4

	F0-1 vs F2-4				F0-2 vs F3-4
	AUROC	SD	95% CI	AdAUC	AUROC	SD	95% CI
APRI	0.71	0.06	0.59-0.83	0.75	0.80	0.06	0.67-0.92
FIB-4	0.75	0.06	0.63-0.87	0.79	0.87	0.06	0.76-0.99
Forn’s index	0.79	0.05	0.69-0.90	0.83	0.86	0.06	0.75-0.96
Hepascore	0.80	0.05	0.70-0.91	0.84	0.95	0.02	0.90-0.99
SLFG	0.83	0.05	0.73-0.93	0.86	0.93	0.03	0.87-0.99
Fibrometer	0.85	0.05	0.75-0.94	0.88	0.94	0.03	0.88-0.99

Table 3 Sensitivity, specificity, predictive values and likelihood ratios of scores according to different cutoffs for the diagnosis of significant fibrosis

Score	Cutoff	%	Significant fibrosis (F2-4)
			Sen	Spe	PPV	NPV	+LR	-LR
APRI	< 0.50	27	0.84	0.35	0.47	0.76	1.29	0.46
	> 1.50	32	0.47	0.80	0.62	0.69	2.35	0.66
FIB-4	< 1.45	65	0.63	0.85	0.74	0.76	4.20	0.44
	> 3.25	13	0.25	0.96	0.80	0.65	6.25	0.78
Forn’s index	< 4.20	46	0.75	0.63	0.59	0.78	2.03	0.40
	> 6.90	18	0.34	0.96	0.85	0.68	8.50	0.69
Hepascore	< 0.50	23	0.88	0.50	0.55	0.85	1.74	0.26
	> 0.84	27	0.50	0.91	0.80	0.72	5.56	0.55
SLFG	< 3.00	23	0.91	0.33	0.48	0.83	1.36	0.27
	> 8.70	22	0.47	0.96	0.88	0.72	11.75	0.55

Sen: Sensitivity; Spe: Specificity; PPV: Positive predictive value; NPV: Negative predictive value; +LR: Positive likelihood ratio; -LR: Negative likelihood ratio.

Table 4 Percentage of classifiable subjects, correct prediction, diagnostic accuracy and biopsies that could be avoided n (%)

Models	Cut-offs	Classifiable subjects	Correct prediction	Diagnostic accuracy	Biopsy avoided
APRI	< 0.50	21 (27)	16 (76)	67%	31 (40)
	> 1.50	25 (32)	15 (62)
FIB-4	< 1.45	51 (65)	39 (76)	77%	47 (60)
	> 3.25	10 (13)	8 (80)
Forn’s index	< 4.20	36 (46)	28 (78)	80%	40 (51)
	> 6.90	14 (18)	12 (85)
Hepascore	< 0.50	18 (23)	15 (85)	82%	32 (41)
	> 0.84	21 (27)	17 (80)
SLFG	< 3.00	18 (23)	15 (83)	86%	30 (38)
	> 8.70	17 (22)	15 (88)