Combined Predictive Value Of Serological Indicators For The Severity Of Early Chronic Hepatitis B Cirrhosis

Background and PurposeAbout 600,000 people die of liver cirrhosis or hepatocellular carcinoma caused by chronic hepatitis B(CHB)in China each year.CHB has become one of the most important issues that threaten the health of Chinese.Early diagnosis and aggressive treatment of CHB cirrhosis are crucial in improving prognosis of patients,which can block or even reverse the progression of liver fibrosis.Liver biopsy is the gold standard for diagnosing CHB liver fibrosis.However,it was limited in clinical application for its invasion and high cost so that it’s unacceptable to patients.In recent years,researches have focused on non-invasive serological indicators in predicting the severity of CHB liver fibrosis.It is a simple and repeatable method,but the diagnostic value to predict early-stage CHB cirrhosis is still unclear.The aim of this study was to evaluate the predictive value of FIB-4,APRI,NLR,LMR,RLR and PLR for early CHB liver cirrhosis.Furthermore,the predictive value of combination of serological indicators in early CHB liver cirrhosis is still unclear.MethodsThis was a single-center retrospective study and a total of 1000 CHB patients were enrolled.According to clinical presentation,laboratory results and imaging examination,patients were divided into the following three groups: CHB group(n=298),compensatory CHB cirrhosis group(n=342)and decompensatory CHB cirrhosis group(n=360).The study evaluated the diagnostic value of non-invasive serological indicators FIB-4,APRI,NLR,LMR,PLR and RLR in clarification the severity of CHB patients,especially for early-stage CHB cirrhosis.In addition,multiple noninvasive serological evaluation methods were combined to construct a diagnosis model for early CHB cirrhosis.ResultsNLR,FIB-4,APRI and RLR was significantly increased during the progression from CHB to compensated CHB cirrhosis and decompensated CHB cirrhosis(P <0.001).Compared with CHB group and compensated CHB cirrhosis group,decompensated CHB cirrhosis group had lower LMR value(P < 0.001).PLR values??were lower in compensated CHB cirrhosis group(P < 0.001).The AUROC values of FIB-4,APRI and RLR were 0.733,0.651 and 0.665,respectively(P < 0.001),while the AUROC values of NLR,LMR and PLR were <0.650(P < 0.001)in the CHB group.In the compensated CHB cirrhosis group,the AUROC value of FIB-4 was 0.700(P < 0.001).The AUROC value of NLR,APRI,and PLR was < 0.650(P < 0.001),but the AUROC value of RLR and LMR was not statistically significant.In the decompensated CHB cirrhosis group,the AUROC values of NLR,FIB-4,and RLR were 0.667,0.663 and 0.673,respectively(P <0.001).The AUROC values of LMR and APRI were < 0.650(P < 0.001).The AUROC value of PLR diagnosis was not statistically significant.Using binary logistic regression analysis and multivariate ROC curve analysis,the AUROC values of combined diagnosis model of GGT+INR+NLR+RLR+PLR and GGT+INR+NLR+FIB-4+APRI+RLR+PLR were 0.792 and 0.793(P < 0.001),indicating better diagnostic value of combined noninvasive serological indexes.ConclusionsFib-4,a noninvasive serological indicator,is valuable for evaluating the severity of CHB cirrhosis,but the accuracy needs to be improved.APRI,NLR,LMR,PLR and RLR have limited diagnostic value in evaluating the severity of CHB cirrhosis separately.The combined diagnosis of INR+GGT+NLR+FIB-4+APRI+RLR+PLR and INR+GGT+NLR+RLR+PLR are available to assess the severity of CHB cirrhosis with high predictive value.