In newly-treated patients with chronic HBV infection, which indicators are associated with liver fibrosis?

Introduction Several hepatitis B virus (HBV) serum markers have been identified as risk factors for liver fibrosis in patients with chronic HBV infection, and some noninvasive fibrosis tests based on serum markers are now being used to identify liver fibrosis in patients severity
.

This study aimed to determine the relationship between serum levels of hepatitis B core-associated antigen (HBcrAg) and liver fibrosis in patients with treatment-naïve chronic HBV infection, as well as other markers associated with liver fibrosis
.

Research methods A total of 246 patients with newly diagnosed chronic HBV infection were included in this study
.

All patients underwent liver biopsy at baseline
.

Liver fibrosis was staged using the METAVIR score, and 15, 140, 50, 26, and 15 patients had liver fibrosis in stages F0, F1, F2, F3, and F4, respectively
.

Biochemical, serological and virological parameters were measured using standard laboratory procedures
.

Serum levels of HBcrAg in patients were detected by ELISA
.

Serum HBcrAg levels were significantly higher in patients with F2, F3, and F4 stages compared with patients without significant liver fibrosis (METAVIR score F0-F1 stage), but there was no significant difference between patients with F2, F3, and F4 stages
.

Serum HBcrAg (OR, 2.
18; 95%CI, 1.
51-3.
16), albumin (ALB) (OR, 0.
60; 95%CI, 0.
41-0.
87), prothrombin activity (PTA) (OR, 0.
58; 95%) CI, 0.
40-0.
83) and platelet (PLT) count (OR, 0.
38; 95% CI, 0.
25-0.
57) were associated with significant liver fibrosis (METAVIR score stages F2-F4) (Table 1)
.

Table 1 Logistic regression analysis of the correlation between liver fibrosis and each index *p<0.
01 Significant liver fibrosis group had significantly lower PLT and PTA
.

PLT decreased significantly with increasing liver fibrosis stage (Fig.
1A)
.

Compared with the group without significant hepatic fibrosis, patients with F3 and F4 stages had significantly lower PTA (Fig.
1C)
.

Compared with the group without significant hepatic fibrosis, the ALB of patients with F2, F3 and F4 stages showed a decreasing trend, but there was no significant difference between these 4 groups (Fig.
1B)
.

Figure 1.
PLT counts and ALB and PTA levels in patients with different stages of serum HBcrAg levels can accurately identify patients with significant liver fibrosis, and the area under the receiver operating characteristic curve (AUROC) was 0.
81 (95% CI, 0.
75-0.
88)
.

APRI, FIB-4 index, and ALBI score identified significant liver fibrosis with areas under the ROC curve of 0.
74 (95%CI, 0.
66-0.
81), 0.
73 (95%CI, 0.
65-0.
80), and 0.
63 (95%CI, 0.
63-0.
80), respectively.
0.
55-0.
72)
.

Compared with these three indicators, the accuracy of identifying significant liver fibrosis based on HBcrAg level was higher than that of FIB-4 index (p=0.
0479) and ALBI score (p=0.
0030)
.

Conclusions This study showed that serum HBcrAg, ALB, PTA levels and PLT counts were associated with significant liver fibrosis in treatment-naïve chronic HBV infection patients
.

Serum HBcrAg level can accurately identify patients with significant liver fibrosis (METAVIR score F2-F4 stage), and HBcrAg level is more effective than FIB-4 index and ALBI score
.

Reference: Liu R, Li M, Lu Y, et al.
Hepatitis B core-related serum levels are associated with significant antigen liver fibrosis in treatment-naive chronic HBV infection patients[J].
J Viral Hepat.
2022 Mar 31.
doi : 10.
1111/jvh.
13674.