Globulin-Platelet (GP) Model Predicts Severe Fibrosis Better Than FIB-4 in Chronic Hepatitis B (CHB) Patients with Mildly Elevated Alanine Aminotransferase (ALT)

Abstract

Background: The disease spectrum of chronic HBV infection is variable, ranging from an inactive chronic hepatitis B (CHB) to cirrhosis and hepatocellular carcinoma. Liver fibrosis stage is an im-portant factor in determining prognosis and need for treatment in patients with chronic HBV infec-tion. The globulin-platelet (GP) model is a new noninvasive liver fibrosis model developed in chronic hepatitis B patients. Objectives: This study aimed to evaluate the diagnostic performance of GP mod-el for liver fibrosis and cirrhosis in CHB patients with mildly elevated alanine aminotransferase (ALT) levels and to compare with the Fibrosis index based on 4 factors (FIB-4). Methods: An obser-vational cross sectional study was carried out in the Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka from February 2018 to February 2019. Patients who met the inclu-sion criteria and escaped the exclusion criteria were counselled and finally 287 were included in the study. Result: Among 287 CHB patients, age range was 18 to 65 years and the mean age was 28.6 ± 9.2 years. The highest frequency was found at 20-30 age groups with 238 males and 49 females. Of all patients, 119 (41.5%) patients had significant fibrosis and among them 49 (17%) had severe fibrosis. Higher scores were observed for GP model in severe fibrosis or cirrhosis group compared with signif-icant and no or minimal fibrosis group. To predict significant fibrosis, at a cutoff value of 1.37, the AUROC of GP was similar with FIB-4 (0.826 vs 0.827), with 82% sensitivity and 75% specificity. To predict severe fibrosis, at cutoff value of 1.49, the AUROC of GP was higher than FIB-4 (0.914 vs 0.830), with a high (100%) sensitivity but moderate (76.5%) specificity. Conclusion: GP model has better diagnostic accuracy in comparison to FIB-4 for assessment of severe fibrosis in CHB patients with high HBV DNA and mildly elevated ALT levels.