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Ran Cheng,1 Ning Tan,2 Hao Luo,2 Qian Kang,2 Xiaoyuan Xu3 1Department of Infectious Diseases, Peking University Third Hospital, Beijing, People’s Republic of China; 2Department of Infectious Diseases, Peking University First Hospital, Beijing, People’s Republic of China; 3Department of Gastroenterology, Peking University First Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xiaoyuan Xu, Department of Gastroenterology, Peking University First Hospital, 8 Xishiku Street, Beijing, 100034, People’s Republic of China, Tel +86-010-83575787, Fax +86-010-83575787, Email xiaoyuanxu6@163.comBackground and Aims: The performance of noninvasive assessments to rule-in or rule-out fibrosis may improve when combined. We aimed to evaluate the efficiencies of sequential algorithms based on the aspartate aminotransferase-to-platelet ratio index (APRI), the fibrosis index based on four factors (FIB-4), and transient elastography (TE) for the assessment of advanced fibrosis (AF) and cirrhosis.Methods: This study enrolled 179 CHB subjects who underwent liver biopsy (LB) before antiviral treatment.Results: AF and cirrhosis were identified in 71 (39.7%) and 28 (15.7%) patients, respectively. Compared with TE alone, sequential FIB-4-TE and APRI-TE algorithms saved a slightly higher number of liver biopsies for the identification of advanced fibrosis (69.3% or 68.2% vs 63.7%, P=0.263 or P=0.372, respectively). For the identification of cirrhosis, sequential FIB-4-TE and APRI-TE algorithms saved a significantly higher number of liver biopsies than TE alone (83.2% or 88.3% vs 69.8%, P=0.003 or P=0.000, respectively). No significant difference was found between the sequential algorithms and TE alone in the diagnostic accuracy for the detection of AF and cirrhosis.Conclusion: The sequential algorithms could significantly reduce the need for liver biopsy with high accuracy for diagnosis of AF and cirrhosis in CHB patients, which would be optimal especially in resource-limited areas.Keywords: noninvasive assessments, advanced liver fibrosis, cirrhosis, chronic hepatitis B |
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