Original article—liver, pancreas, and biliary tract
Clinical Factors Associated With Liver Stiffness in Hepatitis B e Antigen–Positive Chronic Hepatitis B Patients

https://doi.org/10.1016/j.cgh.2008.10.023Get rights and content

Background & Aims

We analyzed the clinical factors associated with advanced liver fibrosis in hepatitis B e antigen (HBeAg)-positive chronic hepatitis B patients.

Methods

We prospectively recruited treatment-naive HBeAg-positive patients for liver stiffness measurement (LSM) by transient elastography. Insignificant and advanced fibrosis was defined as an LSM of 6.0 kPa or less, and greater than 9.0 kPa for patients with alanine aminotransferase (ALT) levels less than or equal to the ƒ upper limit of normal (ULN), and 7.5 kPa or less and greater than 9.0 kPa for those with ALT levels between 1 and 5 × ULN, respectively, based on a previous study with histologic validation.

Results

A total of 453 patients were studied. Among 74 patients who also had a liver biopsy, the cut-off levels for advanced fibrosis had 95% specificity. Age and ALT level, but not hepatitis B virus DNA level, were associated independently with LSM. Based on receiver operating characteristics curve analysis, patients older than 35 years had the highest specificity for advanced fibrosis. The risk of advanced fibrosis increased in patients with an ALT level greater than 0.5 × ULN. Among the 47 patients who were older than 35 years with an ALT level of 0.5 × ULN or less, 39 (83%) had an LSM suggestive of insignificant fibrosis, and 1 (2%) had advanced fibrosis. Among the 217 patients who were older than 35 years with an ALT level greater than 0.5 × ULN, 61 (28%) had LSM indicating insignificant fibrosis, and 80 (37%) had advanced fibrosis.

Conclusions

Risk of advanced liver fibrosis increased in HBeAg-positive patients older than 35 years of age with an ALT level greater than 0.5 × ULN.

Section snippets

Patients and Clinical Evaluation

From July 2006 to March 2008, we conducted a territory-wide screening program from all clinics and hospitals for treatment-naive CHB patients in Hong Kong. In this study, we included CHB patients aged 18 years or older with positive hepatitis B surface antigen (HBsAg) and HBeAg, and negative antibody against HBeAg. We excluded patients who received previous antiviral or interferon treatment. We also excluded patients who were current chronic drinkers (with regular consumption of at least 40 g

Clinical Characteristics

A total of 487 HBeAg-positive CHB patients underwent LSM within the study period. After excluding 11 patients who failed transient elastography because of obesity, 6 patients with unreliable LSM (success rate, <60%), and 17 patients with ALT level greater than 5 × ULN, 453 (93%) patients were included in the analysis (Table 1). The median success rate of LSM was 100% (interquartile range, 81%–100%).

Eighty patients had both transient elastography and liver biopsies; 74 (93%) patients fulfilled

Discussion

In the past, the true prevalence of different severities of liver fibrosis and the immune-tolerance phase was very difficult to study because the indication for liver biopsy in HBeAg-positive patients with normal liver biochemistry is weak. With the availability of transient elastography together with optimal cut-off levels after considering the ALT level, different severities of liver fibrosis could be defined with high specificity.22 In this study, we showed that the prevalence of the

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  • Cited by (0)

    The authors disclose no conflicts.

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