A Noninvasive Model To Predict Liver Inflammation And Fibrosis In Hepatitis B Virus Patients With Normal Liver Function

Aim: Chronic hepatitis B virus(HBV)infected patients with normal alanine aminotransferase(ALT)could not completely avoid the progression of liver disease.Liver biopsy is the "gold standard" to evaluate liver inflammation and fibrosis,but it is invasive.So,we need to establish a noninvasive diagnostic model to evaluate liver inflammation and fibrosis in this part of the population.It could be used to determine antiviral therapy and to prevent liver biopsy in some patients.Methods: A total of 565 chronic HBV infected patients who had received liver biopsy with normal ALT and high level serum HBV DNA were included.And they were randomly divided into training group and validation group.We established a model via univariate and multivariate logistic regression analysis.And the area under receiver operating characteristic curve(AUROC),sensitivity,specificity,positive predictive value,negative predictive value,positive likelihood ratio and negative likelihood ratio were used to evaluate the diagnostic power of the model.Finally,we compared it with other 14 models.Results: Liver necroinflammatory activity and fibrosis-5(LAF-5)was constructed by ALT,albumin to globulin ratio,gamma-glutamyl transpeptidase,platelet and hepatitis B e antigen.The AUROC was 0.793 in the training group,0.842 in the validation group and 0.802 in the entire cohort for predicting moderate to severe inflammation and/or significant fibrosis.We used 85% of the positive predictive value and 85% of the negative predictive value to diagnose and exclude the significant changes of liver histology,respectively.Finally,the LAF-5 model recommended that343 patients(60.71%)should be treated or followed up instead of liver biopsy,with an accuracy of85.71%.In addition,the other 14 noninvasive models were less effective than the LAF-5 model in the diagnosis of moderate to severe inflammation and/or significant fibrosis of the liver.and the AUROCs of them were lower than 0.800.Moreover,the LAF-5 model also had high value in predicting liver inflammation and fibrosis,respectively.Especially for severe inflammation,advanced fibrosis and cirrhosis,with the AUROCs greater than 0.860.Conclusions: A new noninvasive diagnostic model,LAF-5 model,was established.It was composed of simple and routine serum indexes,which could be used in rural areas.The LAF-5model can be used to predict the liver inflammation and fibrosis in HBV infected patients with normal ALT.And it can be used to determine antiviral therapy or followed up instead of liver biopsy in some patients.