The gamma-glutamyl transpeptidase-to-platelet ratio predicts liver fibrosis and cirrhosis in HBeAg-positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China.

The gamma-glutamyl transpeptidase-to-platelet ratio ( GPR) is a new serum diagnostic model, which is reported to be more accurate than aspartate transaminase-to-platelet ratio index ( APRI) and fibrosis index based on the four factors (Fib-4) for the diagnosis of significant fibrosis and cirrhosis in chronic HBV infection ( CHBVI) patients in West Africa. To evaluate the performance of the GPR model for the diagnosis of liver fibrosis and cirrhosis in HBeAg-positive CHBVI patients with high HBV DNA (≥5 log₁₀ copies/mL) and normal or mildly elevated alanine transaminase ( ALT) (≤2 times upper limit of normal ( ULN)) in China. A total of 1521 consecutive CHBVI patients who underwent liver biopsies and routine laboratory tests were retrospectively screened. Of these patients, 401 treatment naïve HBeAg-positive patients with HBV DNA≥5 log₁₀ copies/mL and ALT≤2 ULN were included. The METAVIR scoring system was adopted as the pathological diagnosis standard of liver fibrosis. Using liver histology as a gold standard, the performances of GPR, APRI, and Fib-4 for the diagnosis of liver fibrosis and cirrhosis were evaluated and compared by receiver operating characteristic ( ROC) curves and the area under the ROC curves ( AUROCs). Of 401 patients, 121 (30.2%), 49 (12.2%) and 17 (4.2%) were classified as having significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4), respectively. After estimating the AUROC to predict significant fibrosis, the performance of GPR ( AUROC=0.66, 95% CI 0.60-0.72) was higher than APRI ( AUROC=0.58, 95% CI 0.52-0.64, P=.002) and Fib-4 scores ( AUROC=0.54, 95% CI 0.47-0.60, P<.001). After estimating the AUROC to predict severe fibrosis, the performance of GPR ( AUROC=0.71, 95% CI 0.63-0.80) was also higher than APRI ( AUROC=0.65, 95% CI 0.56-0.73, P=.003) and Fib-4 scores ( AUROC=0.67, 95% CI 0.58-0.75, P=.001). After estimating the AUROC to predict cirrhosis, the performance of GPR ( AUROC=0.73, 95% CI 0.56-0.88) was higher than APRI ( AUROC=0.69, 95% CI 0.54-0.83, P=.041) and Fib-4 scores ( AUROC=0.69, 95% CI 0.55-0.82, P=.012) too. The GPR is a new serum model for the diagnosis of liver fibrosis and cirrhosis and shows obvious advantages in Chinese HBeAg-positive patients with HBV DNA≥5 log₁₀ copies/mL and ALT≤2 ULN compared with APRI and Fib-4, thus warranting its widespread use for this specific population. [ABSTRACT FROM AUTHOR]