Brief Article
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World J Hepatol. Aug 27, 2013; 5(8): 439-444
Published online Aug 27, 2013. doi: 10.4254/wjh.v5.i8.439
Noninvasive assessment of liver damage in chronic hepatitis B
Mehmet Celikbilek, Serkan Dogan, Sebnem Gursoy, Gokmen Zararsız, Alper Yurci, Omer Ozbakır, Kadri Guven, Mehmet Yucesoy
Mehmet Celikbilek, Department of Gastroenterology, Medical School, Bozok University, 66200 Yozgat, Turkey
Serkan Dogan, Sebnem Gursoy, Alper Yurci, Omer Ozbakır, Kadri Guven, Mehmet Yucesoy, Department of Gastroenterology, Medical School, Erciyes University, 38039 Kayseri, Turkey
Gokmen Zararsız, Department of Biostatistics and Medical Informatics, Medical School, Erciyes University, 38039 Kayseri, Turkey
Author contributions: Celikbilek M, Dogan S, Gursoy S, Yurci A, Ozbakır O, Guven K and Yucesoy M contributed to design of the study; Celikbilek M, Dogan S and Gursoy S contributed to data collection; Celikbilek M and Dogan S drafted the manuscript, and revised it in accordance with suggestions from the other authors; Gursoy S contributed to the study conception, analysis data, participated in the critical revision of the manuscript for important intellectual content; Zararsız G performed the statistical analysis; Gursoy S, Yurci A, Ozbakır O, Guven K and Yucesoy M contributed to interpretation of data; Yurci A, Ozbakır O, Guven K and Yucesoy M participated in the critical revision of the manuscript for important intellectual content.
Correspondence to: Mehmet Celikbilek, MD, Department of Gastroenterology, Medical School, Bozok University, 66200 Yozgat, Turkey. drcelikbilek@yahoo.com
Telephone: +90-505-6615375 Fax: +90-354-2140612
Received: April 14, 2013
Revised: June 10, 2013
Accepted: July 18, 2013
Published online: August 27, 2013
Processing time: 159 Days and 17.3 Hours
Abstract

AIM: To evaluate the efficacy of the aspartate aminotransferase/platelet ratio index (APRI) and neutrophil-lymphocyte (N/L) ratio to predict liver damage in chronic hepatitis B (CHB).

METHODS: We analyzed 89 patients diagnosed with CHB by percutaneous liver biopsy and 43 healthy subjects. Liver biopsy materials were stained with hematoxylin-eosin and Masson’s trichrome. Patients’ fibrosis scores and histological activity index (HAI) were calculated according to the Ishak scoring system. Fibrosis score was recognized as follows: F0-1 No /early-stage fibrosis, F2-6 significant fibrosis, F0-4 non-cirrhotic and F5-6 cirrhotic. Significant liver fibrosis was defined as an Ishak score of ≥ 2. APRI and N/L ratio calculation was made by blood test results.

RESULTS: The hepatitis B and control group showed no difference in N/L ratios while there was a significant difference in terms of APRI scores (P < 0.001). Multiple logistic regression analysis revealed that the only independent predictive factor for liver fibrosis in CHB was platelet count. APRI score was significantly higher in cirrhotic patients than in non-cirrhotic patients. However, this significance was not confirmed by multiple logistic regression analysis. The optimum APRI score cut-off point to identify patients with cirrhosis was 1.01 with sensitivity, specificity, positive predictive value and negative predictive value of 62% (36%-86%), 74% (62%-83%), 29% (13%-49%) and 92% (82%-97%), respectively. In addition, correlation analyses revealed that N/L ratio has a negative and significant relationship with HAI (r = -0.218, P = 0.041).

CONCLUSION: N/L ratio was negatively correlated with HAI. APRI score may be useful to exclude cirrhosis in CHB patients.

Keywords: Chronic hepatitis B; Fibrosis; Liver cirrhosis; Noninvasive; Serum markers

Core tip: Due to the limitations of liver biopsy, the use of non-invasive markers has emerged in recent years. The aspartate aminotransferase/platelet ratio index (APRI) is used to determine chronic hepatitis C patients with advanced fibrosis. Neutrophil-lymphocyte (N/L) ratio is higher in patients with advanced fibrosis and considered as a novel non-invasive marker to predict advanced disease in non-alcoholic steatohepatitis. This study showed that N/L ratio is negatively correlated with HAI in chronic hepatitis B (CHB). APRI score may be useful to exclude cirrhosis in CHB patients.