Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2018; 6(12): 521-530
Published online Oct 26, 2018. doi: 10.12998/wjcc.v6.i12.521
Declining diagnostic accuracy of non-invasive fibrosis tests is associated with elevated alanine aminotransferase in chronic hepatitis B
Lin Wang, Yao-Xin Fan, Xiao-Guang Dou
Lin Wang, Yao-Xin Fan, Xiao-Guang Dou, Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, Liaoning Province, China
Author contributions: Wang L and Fan YX designed the study, enrolled the patients, analyzed the data and prepared the manuscript; Dou XG designed and supervised the study.
Supported by the Liaoning Provincial Science and Technology Key Project for Translational Medicine, No. 2014225020; Outstanding Scientific Fund of Shengjing Hospital, No. 201102; Liaoning Provincial Science and Technology Key Project for Translational Medicine, No. 2016509; and National Science and Technology Major Project, Nos. 2017ZX10201201, 2017ZX10202202, 2017ZX10202203.
Institutional review board statement: The study was approved by the Medical Ethics Committee of Shengjing Hospital of China Medical University.
Informed consent statement: Patients were not required to provide informed consent for the study because the analysis used anonymous clinical data obtained after each patient provided written consent for treatment.
Conflict-of-interest statement: All authors declare no conflict of interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiao-Guang Dou, MD, Professor, Department of Infectious Diseases, Shengjing Hospital of China Medical University, No. 39, Huaxiang Road, Shenyang 110022, Liaoning Province, China. guang40@163.com
Telephone: +86-24-9661562211
Received: July 19, 2018
Peer-review started: July 19, 2018
First decision: August 8, 2018
Revised: August 17, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 26, 2018
Abstract
AIM

To explore the effect of alanine aminotransferase (ALT) on the performance of non-invasive fibrosis tests in chronic hepatitis B (CHB) patients.

METHODS

A total of 599 treatment-naive and biopsy-proven CHB patients were included in the study. The cohort was divided into the following three groups: Normal ALT (ALT ≤ 40), slightly elevated ALT (40 < ALT ≤ 80) and elevated ALT (ALT > 80). The diagnostic performance of five common non-invasive fibrosis tests for liver fibrosis (stages S2-4), including the aspartate aminotransferase (AST)-to-platelet (PLT) ratio index (APRI), fibrosis index based on 4 factors (FIB-4), King’s score, Forns index and gamma-glutamyl transpeptidase (GGT)-to-PLT ratio (GPR), were evaluated for each group.

RESULTS

Higher ALT levels were associated with higher non-invasive fibrosis test scores. Patients with the same fibrosis stage but higher ALT levels showed higher non-invasive test scores. The areas under the receiver operating characteristics curves (AUROCs) of the non-invasive tests for prediction of ≥ S2 were higher for patients with ALT ≤ 40 U/L (range 0.705-0.755) and 40 < ALT ≤ 80 U/L (range 0.726-0.79) than for patients with ALT > 80 U/L (range 0.604-0.701). The AUROCs for predicting ≥ S3 and S4 were higher in patients with ALT ≤ 40 U/L (range 0.736-0.814 for ≥ S3, 0.79-0.833 for S4) than in patients with 40 < ALT ≤ 80 U/L (range 0.732-0.754 for ≥ S3, range 0.626-0.723 for S4) and ALT > 80 U/L (range 0.7-0.784 for ≥ S3, range 0.662-0.719 for S4). The diagnostic accuracy of the non-invasive tests decreased in a stepwise manner with the increase in ALT.

CONCLUSION

ALT has a significant effect on the diagnostic performance of non-invasive fibrosis tests. The ALT level should be considered before performing these non-invasive tests.

Keywords: Chronic hepatitis B, Non-invasive tests, Liver fibrosis, Alanine aminotransferase, Inflammation

Core tip: Because of their high applicability and good interlaboratory reproducibility, many convenient non-invasive fibrosis tests have been established. To explore the effect of alanine aminotransferase (ALT) on the performance of non-invasive fibrosis tests in chronic hepatitis B (CHB) patients, we retrospectively analyzed 599 treatment-naive and biopsy-proven CHB patients at our hospital. The diagnostic accuracy of the non-invasive tests decreased in a stepwise manner with the increase in ALT. ALT has a significant effect on the diagnostic performance of non-invasive fibrosis tests.