1. Diagnostic thresholds and performance of noninvasive fibrosis scores are limited by age in patients with chronic hepatitis B
- Author
-
Guang Chen, Xiping Zhao, Ke Ma, Gui-Ping Li, Meifang Han, Lin Wang, Wen-Tao Wang, Xue-Qi Zhao, Qin Ning, Tao Chen, and Yi-Zhi Chen
- Subjects
Adult ,Liver Cirrhosis ,Male ,medicine.medical_specialty ,Biopsy ,Diagnostic accuracy ,Severity of Illness Index ,Gastroenterology ,Young Adult ,03 medical and health sciences ,Hepatitis B, Chronic ,0302 clinical medicine ,Age groups ,Chronic hepatitis ,Predictive Value of Tests ,Fibrosis ,Virology ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Retrospective Studies ,Receiver operating characteristic ,medicine.diagnostic_test ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Infectious Diseases ,ROC Curve ,Liver biopsy ,Female ,030211 gastroenterology & hepatology ,business ,Significant fibrosis - Abstract
Aim We aimed at investigating the effects of age on the predictive performances of noninvasive fibrosis scores for significant fibrosis in patients with chronic hepatitis B (CHB). Methods A total of 496 CHB patients who underwent liver biopsy were stratified into four age groups: ≤30, 31 to 40, 41 to 50, and ≥51 years. Receiver operating characteristic curves were used to evaluate the diagnostic performance of aspartate aminotransferase to platelet ratio index (APRI), fibrosis score-4 (Fib-4) and γ-glutamyl transpeptidase to platelet ratio (GPR) in different age groups. Results The extent of fibrosis significantly increased with age, and the percentage of significant fibrosis (≥F2) was 21.3%, 29.0%, 38.5%, and 46.1%, respectively. All three scores displayed a moderate accuracy to diagnose significant fibrosis in overall patients. However, for patients with age ≤30 years, APRI, Fib-4, and GPR performed poorly with the AUROC of 0.567, 0.627 and 0.596, respectively. Furthermore, using the established cut-off values-1.45 for Fib-4, the sensitivity for significant fibrosis increased with age, from 14.8%, 38.1%, 74.5% to 97.87% in above age groups, respectively. To improve the diagnostic accuracy for significant fibrosis, the proposed low and high cut-off points for Fib-4 were 0.41 and 1.15 in ≤30 years, 0.8 and 1.59 in 31 to 40 years, 1.17 and 1.94 in 41 to 50 years, 1.76 and 3.10 in ≥ 51 years, respectively. Conclusions Age may influence the diagnostic thresholds and performance of APRI, Fib-4, and GPR for significant fibrosis in patients with CHB. In particular, these scores performed poorly for identifying significant fibrosis in younger patients (≤30 years).
- Published
- 2019