Non‐invasive tests for liver disease severity and the hepatocellular carcinoma risk in chronic hepatitis B patients with low‐level viremia

• Published in: Liver international Vol. 38; no. 1; pp. 68 - 75
• Main Authors: Paik, Namyoung, Sinn, Dong H., Lee, Ji H., Oh, In S., Kim, Jung H., Kang, Wonseok, Gwak, Geum‐Youn, Paik, Yong‐Han, Choi, Moon S., Lee, Joon H., Koh, Kwang C., Paik, Seung W.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.01.2018
• Subjects: Adult; Age Factors; Aspartate aminotransferase; Aspartate Aminotransferases - blood; AST to platelet ratio index; Biomarkers; Biomarkers - blood; Carcinoma, Hepatocellular - diagnosis; Carcinoma, Hepatocellular - epidemiology; Carcinoma, Hepatocellular - virology; Cirrhosis; Deoxyribonucleic acid; Disease Progression; DNA; DNA, Viral - blood; DNA, Viral - genetics; Female; Fibrosis; fibrosis‐4 score; Health risks; Hepacivirus - genetics; Hepacivirus - pathogenicity; Hepatitis; Hepatitis B; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - diagnosis; Hepatitis B, Chronic - epidemiology; Hepatitis B, Chronic - virology; Hepatocellular carcinoma; Humans; Incidence; Levels; Liver; Liver cancer; Liver cirrhosis; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Cirrhosis - epidemiology; Liver Cirrhosis - virology; Liver diseases; Liver Function Tests; Liver Neoplasms - diagnosis; Liver Neoplasms - epidemiology; Liver Neoplasms - virology; low‐level viremia; Male; Middle Aged; Patients; Platelet Count; Predictive Value of Tests; Prognosis; Reproducibility of Results; Retrospective Studies; Risk; Risk Assessment; Risk Factors; Seoul - epidemiology; Severity of Illness Index; Time Factors; Ultrasonography; Ultrasound; Viral Load; Viremia; Viremia - diagnosis; Viremia - virology; Viruses; Seoul; low-level viremia; AST to platelet ratio index; fibrosis-4 score; hepatocellular carcinoma
• ISSN: 1478-3223; 1478-3231
• DOI: 10.1111/liv.13489

Background & Aims We tested whether non‐invasive tests for liver disease severity can stratify hepatocellular carcinoma (HCC) risk in chronic hepatitis B virus (HBV)‐infected patients showing low‐level viremia (LLV, HBV DNA <2000 IU/mL). Methods A retrospective cohort of 1006 chronic hepatitis B patients showing persistently LLV, defined by at least two consecutive assessments in the year before enrolment, was assessed for HCC development. Two non‐invasive serum biomarkers, the aspartate aminotransferase to platelet ratio index (APRI) and the Fibrosis‐4 (FIB‐4), were tested. Cirrhosis was defined with ultrasonography. Results During a median 5.1 years of follow‐up, HCC developed in 36 patients. HCC incidence rate at 5 years was significantly higher for cirrhotic patients (19/139, 13.7%), but was not null for non‐cirrhotic patients (17/867, 2.0%, P<.001). APRI at a cut‐off of 0.5 was more specific but less sensitive for HCC development, and FIB‐4 at a cut‐off of 1.45 was more sensitive but less specific. When both APRI and FIB‐4 were used to group patients, the 5‐year cumulative HCC incidence rate was 13.9%, 1.4% and 1.2% for both high, any high, and both low APRI and FIB‐4 score among all patients (n=1006, P<.001), respectively, and was 11.4%, 1.5% and 0.4% in the same respective order among non‐cirrhotic patients (n=867, P<.001). Conclusions The combined use of two non‐invasive serum biomarkers (APRI and FIB‐4) could stratify HCC risk for chronic HBV‐infected patients with LLV.