The Gamma-Glutamyl-Transpeptidase to Platelet Ratio Does not Show Advantages than APRI and Fib-4 in Diagnosing Significant Fibrosis and Cirrhosis in Patients With Chronic Hepatitis B

The gamma-glutamyl-transpeptidase to platelet ratio (GPR) is a new liver fibrosis model, which is reported to be more accurate than aspartate transaminase (AST) to platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for diagnosing significant fibrosis and cirrhosis in patients with chronic hepatitis B (CHB) in West Africa. The aim of this study is to assess the diagnostic accuracy of GPR for significant fibrosis and cirrhosis in Chinese CHB patients, and explore whether GPR deserves to be popularized in China. A total of 372 CHB patients who underwent liver biopsies and routine laboratory tests were retrospectively studied. The Scheuer scoring system was adopted as the pathological standard of liver fibrosis. Using liver histology as a gold standard, the diagnostic accuracies of GPR, APRI, and Fib-4 for significant fibrosis and cirrhosis are evaluated and compared by the receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of these 372 patients, 176 (47.3%), 129 (34.7%), and 72 (19.4%) were classified as having significant fibrosis ( S2), severe fibrosis ( S3), and cirrhosis (S4), respectively. The AUROCs of GPR for significant fibrosis (0.72 vs. 0.78; P1⁄4 0.01), severe fibrosis (0.75 vs. 0.80; P1⁄4 0.04), and cirrhosis (0.78 vs. 0.83; P1⁄4 0.02) were lower than those , PhD, Xinyan Li, M o, MM, , MM, Xun Qi, PhD, and Liang Chen, MD GPR is a new serum diagnostic model for liver fibrosis and cirrhosis, but does not show advantages than APRI and Fib-4 in identifying significant fibrosis, severe fibrosis, and cirrhosis in CHB patients in China. (Medicine 95(16):e3372) Abbreviations: ALT = alanine transaminase, APRI = aspartate transaminase to platelet ratio index, AST = aspartate transaminase, AUROC = area under receiver operating characteristic curve, CHB = chronic hepatitis B, CI = confidence interval, Fib-4 = fibrosis index based on the 4 factors, GGT = gamma-glutamyltranspeptidase, GPR = gamma-glutamyl-transpeptidase to platelet ratio, HBeAg = hepatitis B virus e antigen, HBsAg = hepatitis B virus surface antigen, HBV = hepatitis B virus, NPV = negative predictive value, PPV = positive predictive value, ROCcurve = receiver operating characteristic curve. INTRODUCTION I n China, hepatitis B virus (HBV) infection is moderately endemic, and chronic hepatitis B (CHB) is the main cause of hepatocellular carcinoma (HCC), which is one of the most frequent cancers in China. The CHB patients with significant fibrosis and cirrhosis have a higher chance of developing liver decompensation, HCC, and death. To reduce the disease burden of HBV infection, it may be critical to identify patients with significant fibrosis and cirrhosis, and treat them immediately. However, liver biopsy, the gold standard for diagnosing liver fibrosis and cirrhosis, is not performed in all hospitals (especially in primary care) because of its invasiveness, expensive procedure, and complications. Transient elastography (Fibroscan), which measures liver stiffness, is increasingly being recognized as an excellent tool for diagnosing liver fibrosis and cirrhosis because of its noninvasive nature, reproducibility, and high diagnostic performance. However, the Fibroscan device is expensive (s34,000 for the portable machine) and requires annual maintenance (s5000). In China, the machine is often only accessible in the main hospitals in the main cities. Thus, simple, inexpensive, and noninvasive fibrosis models are still urgently needed in China. In recent years, the development of new serum models for diagnosing liver fibrosis and cirrhosis has been a hot research topic. Simple models such as the aspartate transaminase (AST) PRI) and the fibrosis index based on the ave the advantage of comprising only tests, which are available in primary www.md-journal.com | 1 care. The first WHO guidelines on the prevention, care, and treatment of patients with CHB recommended APRI and Fib-4 as noninvasive tools to detect cirrhosis in resource-limited settings. However, the APRI and Fib-4 have faced some problems, such as the low level of sensitivity and positive predictive value (PPV) for diagnosing cirrhosis, and the lack of enough accuracy for diagnosing mild to moderate liver fibrosis. Accordingly, the new fibrosis models are needed urgently. In June 2015, Lemoine et al identified a new serum fibrosis model, the gamma-glutamyl-transpeptidase (GGT) to platelet ratio (GPR), in a cohort of 135 CHB patients in Gambia, West Africa, and then assessed its diagnostic accuracy in two external validation cohorts (80 patients from Senegal, West Africa, and 63 patients from France, Europe, respectively). The results show that GPR is more accurate than APRI and Fib-4 in West Africa, but not superior to APRI and Fib-4 in France. As the authors conclude, because of the small sample, there is no consensus in the three cohorts, GPR needs further evaluation in other cohorts. At present, there is a lack of data about the diagnostic value of GPR for liver fibrosis and cirrhosis in CHB patients in China, and clinical research is needed to verify whether GPR deserves to be popularized in China. Using liver histology as a gold standard, we compared the performances of GPR, APRI, and Fib-4 for diagnosing significant fibrosis and cirrhosis in 372 CHB patients, and explored whether GPR deserves to be popularized in China. MATERIALS AND METHODS