Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B

Table 3 Areas under the receiver operating characteristics curves of the non-invasive tests for prediction of significant fibrosis, advanced fibrosis and cirrhosis in the different alanine aminotransferase groups

Tests	ALT ≤ 40			40 < ALT ≤ 80			ALT > 80
	≥ S2	≥ S3	S4	≥ S2	≥ S3	S4	≥ S2	≥ S3	S4
APRI
AUROC 95%CI P-value Diagnostic accuracy (optimized cut off)	0.746 0.676-0.815 < 0.001 75.74% (≤ 0.5) 73.90% (> 1.5)	0.795 0.716-0.873 < 0.001 -	0.833 0.744-0.922 < 0.001 93.01% (< 1.0) 93.75% (≥ 2.0)	0.79 0.727-0.854 < 0.001 62.63% (≤ 0.5) 72.63% (> 1.5)	0.751 0.678-0.824 < 0.001 -	0.626 0.519-0.732 0.182 83.68% (< 1.0) 94.21% (≥ 2.0)	0.701 0.612-0.789 < 0.001 45.99% (≤ 0.5) 66.42% (> 1.5)	0.778 0.688-0.868 < 0.001 -	0.71 0.568-0.851 0.021 42.34% (< 1.0) 77.37% (≥ 2.0)
FIB-4
AUROC 95%CI P-value Diagnostic accuracy (optimized cut off)	0.705 0.635-0.774 < 0.001 -	0.736 0.647-0.825 < 0.001 78.68% (< 1.45) 87.13% (> 3.25)	0.792 0.665-0.919 < 0.001 -	0.767 0.699-0.836 < 0.001 -	0.747 0.666-0.829 < 0.001 72.63% (< 1.45) 85.79% (> 3.25)	0.663 0.563-0.763 0.083 -	0.672 0.582-0.762 0.001 -	0.765 0.668-0.863 < 0.001 72.26% (< 1.45) 81.02% (> 3.25)	0.698 0.533-0.862 0.03 -
GPR
AUROC 95%CI P-value Diagnostic accuracy (optimized cut off)	0.755 0.684-0.826 < 0.001 81.62% (≥ 0.32)	0.814 0.737-0.892 < 0.001 87.13% (≥ 0.32)	0.799 0.69-0.907 < 0.001 93.01% (≥ 0.56)	0.726 0.648-0.803 < 0.001 71.05% (≥ 0.32)	0.732 0.633-0.83 < 0.001 70.53% (≥ 0.32)	0.723 0.607-0.839 0.018 84.74% (≥ 0.56)	0.696 0.607-00.785 < 0.001 61.31% (≥ 0.32)	0.748 0.654-0.841 < 0.001 52.55% (≥ 0.32)	0.693 0.58-0.807 0.034 65.69% (≥ 0.56)
King’s score
AUROC 95%CI P-value Diagnostic accuracy (optimized cut off)	0.75 0.685-0.816 < 0.001 77.21% (≥ 12.3)	0.773 0.689-0.857 < 0.001 -	0.831 0.733-0.929 < 0.001 94.44% (> 16.7)	0.781 0.715-0.847 < 0.001 72.11% (≥ 12.3)	0.751 0.672-0.83 < 0.001 -	0.659 0.56-0.759 0.09 87.37% (> 16.7)	0.69 0.601-0.779 0.001 43.80% (≥ 12.3)	0.784 0.694-0.874 < 0.001 -	0.719 0.577-0.862 0.016 61.31% (> 16.7)
Forns index
AUROC 95%CI P-value Diagnostic accuracy (optimized cut off)	0.731 0.661-0.8 < 0.001 33.09% (< 4.2) 68.75% (> 6.9)	0.758 0.668-0.849 < 0.001 -	0.79 0.665-0.915 < 0.001 -	0.752 0.677-0.827 < 0.001 35.79% (< 4.2) 66.84% (> 6.9)	0.754 0.66-0.848 < 0.001 -	0.708 0.587-0.829 0.027 -	0.604 0.508-0.7 0.038 46.72% (< 4.2) 58.39% (> 6.9)	0.7 0.588-0.81 0.001 -	0.662 0.485-0.838 0.076 -

ALT: Alanine aminotransferase; S: Stage of fibrosis; GPR: Gamma-glutamyl transpeptidase (GGT)-to-platelet ratio; APRI: Aspartate aminotransferase (AST)-to-platelet (PLT) ratio index; FIB-4: Fibrosis index based on 4 factors; AUROC: Areas under the receiver operating characteristics curve.