Evaluation of liver fibrosis in hepatitis B carriers with NON-invasive methods

Purpose: To compare the diagnostic performance of 3 different noninvasive examination methods, FIB-4 score, APRI score, and Transient Elastography (TE) in predicting liver fibrosis in patients with HbeAg negative chronic infection phase (inactive carriers according to the old terminology) and to reveal the importance of these parameters in the follow-up of patients in the HbeAg negative chronic infection phase. Material and Methods: A total of 204 patients, 120 with HbeAg negative chronic infection and 84 with HbeAg negative chronic hepatitis B, were included in the study. Laboratory data, APRI, FIB-4 scores and fibroscan findings (kPa, CAP) of the patients with HbeAg negative chronic infection at the time of diagnosis and at the 1st, 3rd, 5th years and at the last admission, respectively, were scanned from the retrospective polyclinic files. These data were compared with the data of HbeAg negative chronic hepatitis B patients selected as the control group, at the time of diagnosis and at the last admission. Results: Among the patients participating in the study, 106 (52.0%) were female and 98 (48.0%) were male. However, it was found that female gender (62.5%) was statistically significantly higher in HbeAg-negative chronic infection group and male gender (63.1%) in HBeAg-negative chronic hepatitis B patients (p=0.000). The mean age of the patients was 53.31±10.69 years and the mean age at diagnosis was 45.25±10.48 years. Analysis of clinical and laboratory findings collected after 0, 1, 3, 5 years and the last visit from HbeAg negative chronic infection patients showed that the ALT score at the last visit was relatively low compared to the time of diagnosis (p=0.052) and the FIB-4 score at the last visit was statistically significantly higher than at diagnosis (p=0.004). As a result of comparing fibroscan parameters and clinical biomarkers, kPA was statistically significantly higher in patients with CHB (7.83±7.33 vs. 5.17±1.50) (p=0.012). Furthermore, the Fibroscan evaluation showed no statistically significant difference when the time of diagnosis and current biochemical parameters as well as APRI and FIB-4 scores of only 6 patients with HbeAg negative chronic infection with kPA values above 7 were compared with the data of patients with other HbeAg negative chronic infection (p>0.05). Conclusion: In our study, although the mean APRI index, FIB-4 score and viral load of patients with chronic hepatitis B at diagnosis were found to be significantly higher than those of patients with HbeAg negative chronic infection, it was observed that these parameters lost their sensitivity between groups at post-treatment. In addition, Fibroscan application at the end of the follow-up period found that kPA was statistically significantly higher in patients with CHB compared to the HbeAg negative chronic infection group. Moreover, it was found that the scores for high/severe fibrosis (F2, F3, F4) were statistically significantly lower in patients with HbeAg negative chronic infection. In addition, as a result of fibroscan evaluation, a value of >7 kPA, which is considered cut-off for significant fibrosis, was found in many published studies in our 6 patients with HbeAg negative chronic infection. Although the APRI index and FIB-4 score from non-invasive tests have diagnostic value for significant fibrosis, they are inadequate for routine use in therapy monitoring and observation of patients with HbeAg negative chronic infection, and although liver biopsy is still maintaining its gold standard today, we believe that the use of fibroscan will reduce unnecessary biopsies and contribute to selectivity in the use of liver biopsy. Key words: HbeAg negative chronic infection; FibroScan; Fibrosis ; APRI ; FIB-4