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

Figure 1 Flow chart of the study population selection. HCC: Hepatocellular carcinoma; HIV: Human immunodeficiency virus; HBV: Hepatitis B virus.

Figure 2 Receiver operating characteristic curve analysis of non-invasive tests for prediction of liver fibrosis stages (S2-4) in the different alanine aminotransferase groups. A-C: Predicting liver fibrosis in the normal alanine aminotransferase (ALT) group; A: For significant fibrosis (≥ S2); B: For advanced fibrosis (≥S3); C: for cirrhosis (S4); D-F: Predicting liver fibrosis in the slightly elevated ALT group; D: For significant fibrosis (≥ S2); E: For advanced fibrosis (≥ S3); F: For cirrhosis (S4); G-I: Predicting liver fibrosis in the elevated ALT group; G: For significant fibrosis (≥ S2); H: For advanced fibrosis (≥ S3); I: For cirrhosis (S4). 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.

Figure 3 Relationship between serum alanine aminotransferase and the diagnostic accuracy of non-invasive fibrosis tests in chronic hepatitis B patients. A: Significant fibrosis (≥ S2); B: Advanced fibrosis (≥ S3); C: Cirrhosis (S4). The fibrosis stages are based on Scheuer’s classification. ALT: Alanine aminotransferase; 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.