A simple algorithm for non-invasive diagnosis of significant liver histological changes in patients with CHB and normal or mildly elevated alanine transaminase levels.

Abstract	Significant liver histological changes (SLHC) were defined as moderate to severe liver inflammation (A2 or higher) and/or fibrosis (F2 or higher) using the METAVIR scoring system. This study aimed to develop an algorithm for the non-invasive detection of SLHC in patients with chronic hepatitis B (CHB) and normal or mildly elevated alanine transaminase (ALT) levels.Using liver histology as gold standard, we developed a simple algorithm for the diagnosis of SLHC in a training set (504 patients), and then validated the diagnostic accuracy in a validation set (166 patients).A new algorithm (AAG) attributed to age, ALT, and gamma-glutamyl transpeptidase (GGT) was developed. In the training set, the area under ROC curve (AUROC) of AAG was significantly higher than that of ALT, aspartate transaminase (AST), GPR, and APRI for the diagnosis of SLHC (0.74, 0.68, 0.65, 0.56, and 0.53, respectively; all P < .05). In the validation set, the AUROC of AAG was also higher than that of ALT, AST, GPR, and APRI (0.73, 0.65, 0.62, 0.62, and 0.61, respectively; all P < .05). Using AAG ≥ 2, the sensitivity and negative predictive value was 84% to 98% and 75% to 94%, respectively, for the diagnosis of SLHC. Using AAG ≥ 6, the specificity and positive predictive value was 93% to 97% and 67% to 79%, respectively, for the diagnosis of SLHC.The AAG algorithm represents a novel noninvasive method for the diagnosis of SLHC in CHB patients with normal or mildly elevated ALT levels.
Authors	Qiang Li, Chenlu Huang, Wei Xu, Qiankun Hu, Liang Chen
Journal	Medicine (Medicine (Baltimore)) Vol. 98 Issue 28 Pg. e16429 (Jul 2019) ISSN: 1536-5964 [Electronic] United States
PMID	31305465 (Publication Type: Journal Article, Validation Study)
Chemical References	Biomarkers Alanine Transaminase
Topics	Adult Alanine Transaminase (blood) Algorithms Biomarkers (blood) Biopsy Female Hepatitis B, Chronic (diagnosis, enzymology) Humans Inflammation (diagnosis, enzymology) Liver (pathology) Liver Cirrhosis (diagnosis, enzymology) Male Retrospective Studies Sensitivity and Specificity

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