Application of the HALF index obviates the need for liver biopsy in half of all patients with chronic hepatitis B

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1746.2010.06609.x/abstract

Application of the HALF index obviates the need for liver biopsy in half of all

patients with chronic hepatitis B

Hyun Jung Lee1, Yeon Seok Seo1,*, Dong Jin Kim1, Hyun Seok Kang1, Hyonggin An2,

Ji Hoon Kim1, Jae Youn Cheong3, Hyung Joon Yim1, Jong Eun Yeon1, Hong Sik Lee1,

Kwan Soo Byun1, Sung Won Cho3, Dong Joon Kim4, Soon Ho Um1, Chang Duck Kim1, Ho

Sang Ryu1Article first published online: 12 MAY 2011

DOI: 10.1111/j.1440-1746.2010.06609.x

© 2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell

Publishing Asia Pty Ltd

Issue

Journal of Gastroenterology and Hepatology

Volume 26, Issue 6, pages 987–995, June 2011

Abstract

Background and Aims:  Transient elastography (TE) is useful for predicting the

fibrosis stage, but it is unsatisfactory as a substitute for liver biopsy,

especially in patients with chronic hepatitis B (CHB). This study was performed

to establish a reliable model for predicting significant fibrosis (SF) in

patients with CHB.

Methods:  All CHB patients who were admitted to undergo liver biopsy were

enrolled. They were randomly classified into either a training set (n = 139) or

a validation set (n = 69). A model for predicting SF was established in the

training set and validated in the validation set. Low and high cutoff values

(COVs) were chosen for sensitivity ≥ 99% and specificity ≥ 99%,

respectively.

Results:  A total of 208 patients were enrolled. Age was 39 ± 12 years and

149 (71.6%) were men. In the training set, liver stiffness values and serum

haptoglobin, apolipoprotein A1, and α2-macroglobulin levels were independent

predictors of SF on multivariate analysis. These variables were used to

construct a novel model, called the HALF index. The area under the receiver

operating characteristics curve of the HALF index for predicting SF was

significantly higher than that of TE alone (0.915 vs 0.877, P = 0.010). Using

low and high COVs of the HALF index, it appears that approximately half (47.1%)

of patients could avoid liver biopsy, with an associated accuracy of 99.0%.

Conclusion:  A combination of liver stiffness and serum markers identified SF

with a high degree of accuracy. Approximately half of all patients with CHB

could avoid liver biopsy through the utilization of the HALF index.