| ObjectiveTo investigate the clinical value of G?teborg University Cirrhosis Index(GUCI)score in the noninvasive diagnosis of liver fibrosis stage in patients with chronic hepatitis B virus(HBV)infection by comparing it with the classical noninvasive serological diagnosis models of aspartate aminotransferase-to-platelet ratio index(APRI)score and fibrosis-4(FIB-4)index for liver fibrosis.MethodsA total of 846 patients with chronic HBV infection who underwent liver biopsy in The Second Affiliated Hospital of Anhui Medical University from January2010 to December 2016 were enrolled and divided into marked liver fibrosis(stage ≥S2)group with 396 patients,severe liver fibrosis(stage ≥S3)group with 204 patients,and liver cirrhosis(stage S4)group with 100 patients.Of all 846 patients,637 patients had alanine aminotransferase(ALT)<2×upper limit of normal(ULN),among whom 275 patients had marked liver fibrosis(stage ≥S2),143 patients had severe liver fibrosis(stage ≥S3),and 73 patients had liver cirrhosis(stage S4);there were 375 patients HBeAg-positive patients,among whom 172 patients had marked liver fibrosis(stage≥S2),90 patients had severe liver fibrosis(stage ≥S3),and 42 patients had livercirrhosis(stage S4);there were 471 patients HBeAg-negative patients,among whom224 patients had marked liver fibrosis(stage ≥S2),114 patients had severe liver fibrosis(stage ≥S3),and 58 patients had liver cirrhosis(stage S4).Liver biopsy was performed for all patients,and clinical indices of routine blood test,liver function,and coagulation function were measured on the same day of liver biopsy to calculate GUCI score,APRI score,and FIB-4 index.An analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H rank sum 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 between multiple groups;the Spearman correlation analysis was used to investigate rank correlation between three serological models and liver fibrosis stage.The receiver operating characteristic(ROC)curve was plotted to analyze the diagnostic efficacy of three serological models for liver fibrosis,and the Z test was used for comparison of the area under the ROC curve(AUC).Results1.In 846 patients with chronic HBV infection,GUCI score,APRI score,and FIB-4index were positively correlated with liver fibrosis stage(r=0.472,0.435,and 0.401,all P<0.001);aspartate aminotransferase(AST)level and prothrombin time-international normalized ratio(PT-INR)were positively correlated with liver fibrosis degree in patients with hepatitis B(r=0.316 and 0.401,both P<0.001);platelet count(PLT)was negatively correlated with liver fibrosis degree in patients with hepatitis B(r=-0.353,P< 0.001).This result was also seen in 637 patients with ALT < 2 × ULN and 471HBeAg-negative patients and 375 HBeAg-positive patients.2.In 846 patients with chronic HBV infection,GUCI score had a higher AUC than APRIscore and FIB-4 index in the diagnosis of marked liver fibrosis(Z=6.291 and 3.159,both P < 0.001)and a higher AUC than APRI score in the diagnosis of severe liver fibrosis(Z=5.306,P<0.0001),but no significant difference was observed between the AUCs of GUCI score and FIB-4 index in the diagnosis of severe liver fibrosis(Z=2.108,P=0.0550).There were no significant difference between the AUCs of APRI score(Z=0.475,P=0.635),FIB-4 index(Z=1.223,P=0.222)and GUCI score in the diagnosis of liver cirrhosis.3.In 637 patients with ALT<2×ULN,GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked or severe liver fibrosis(marked liver fibrosis: Z=5.969 and 3.089,both P<0.01;severe liver fibrosis: Z=4.455 and 3.192,both P<0.01).There were no significant difference between the AUCs of APRI score(Z=0.949,P=0.343),FIB-4 index(Z=0.019,P=0.985)and GUCI score in the diagnosis of liver cirrhosis.4.In 471 HBeAg-negative patients,GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis(Z=5.725 and 2.162,both P<0.05)and a higher AUC than APRI score in the diagnosis of severe liver fibrosis(Z=4.743,P<0.001),but no significant difference was observed between the AUCs of GUCI score and FIB-4 index in the diagnosis of severe liver fibrosis(Z=1.732,P=0.083).There were no significant difference between the AUCs of APRI score(Z=0.657,P=0.511),FIB-4 index(Z=0.372,P=0.710)and GUCI score in the diagnosis of liver cirrhosis.5.In 375 HBeAg-positive patients,GUCI score had a higher AUC than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis(Z=3.035 and 3.774,both P<0.05)and a higher AUC than APRI score in the diagnosis of severe liver fibrosis(Z=3451.,P<0.05),but no significant difference was observed between the AUCs of GUCI scoreand FIB-4 index in the diagnosis of severe liver fibrosis(Z=1.192,P=0.233).There were no significant difference between the AUCs of APRI score(Z=1.345,P=0.179),FIB-4 index(Z=0.420,P=0.675)and GUCI score in the diagnosis of liver cirrhosis.5.In the patients with ALT<2×ULN,at the cut-off value of 0.446,GUCI score had a sensitivity of 61.82%,a specificity of 82.73%,a positive predictive value of 73.14%,and a negative predictive value of 74.02% in the diagnosis of marked liver fibrosis(P<0.001);at the cut-off value of 0.492,GUCI score had a sensitivity of 76.92%,a specificity of 72.30%,a positive predictive value of 44.49%,and a negative predictive value of 91.56% in the diagnosis of severe liver fibrosis(P<0.001);at the cut-off value of 0.499,GUCI score had a sensitivity of 72.00%,a specificity of 77.90%,a positive predictive value of 29.74%,and a negative predictive value of 95.54% in the diagnosis of liver cirrhosis(P<0.001).ConclusionGUCI score is a simple and practical serological model for the diagnosis of liver fibrosis,especially for patients with chronic HBV infection with ALT<2×ULN,GUCI score has a higher value than APRI score and FIB-4 index in the diagnosis of marked liver fibrosis and severe liver fibrosis;as for the diagnosis of cirrhosis,GUCI score has a similar diagnostic value as APRI score and FIB-4 index. |
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