Investigation of the efficacy of noninvasive fibrosis markers in predicting hepatic fibrosis in chronic hepatitis B

Aim: Today, morbidity and mortality rates due to Chronic Hepatitis B are still high globally. The gold standard method for detecting necroinflammation and fibrosis stages in the liver during the diagnosis and treatment of Chronic Hepatitis B patients is liver biopsy. In recent years, studies in the literature has become increasingly common for cheaper, non-invasive, and easy-to-repeat methods although these methods does not completely replace biopsy. For this purpose, in this study, 15 different noninvasive fibrosis markers previously defined in the literature were examined and their diagnostic performance in predicting liver fibrosis and necroinflammation was investigated. Materials and Methods: Age, gender, comorbidity, ALT, AST, ALP, GGT, total bilirubin, albumin, INR, PTZ, MPV, RDW, neutrophil, lymphocyte, platelet, hemoglobin, HBV-DNA and according to ISHAK scoring system, HAI and fibrosis data of Chronic Hepatitis B patients who is over the age of eighteen and had a biopsy, were recorded by scanning outpatient modules. Then, the study population was divided into different groups according to the grades of moderate fibrosis (F≥2), significant fibrosis (F≥3), advanced fibrosis (F≥4), cirrhosis (F≥5) and HAI ≥6 and after that ROC analysis was performed to examine the diagnostic performances of noninvasive fibrosis markers at different fibrosis stages. Results: Of the fifteen noninvasive fibrosis markers investigated; API, APRI, FIB-4, GAR, GPR, GUCI, KING and RPR markers were found to be predict liver fibrosis significantly in all fibrosis stages. In contrast, NLR, MLR and BONACINI markers could not significantly predict liver fibrosis in any fibrosis stage. In particular, six noninvasive fibrosis markers' area under the curve was 0.800 and above that means high diagnostic power while predicting cirrhosis (F≥5) and it was determined that the diagnostic performance of fibrosis markers increased in correlation with the stages of fibrosis. In addition, KING was found to have the highest diagnostic power in predicting moderate fibrosis (F≥2), significant fibrosis (F≥3) and advanced fibrosis (F≥4); FIB-4 was also found to have the highest diagnostic power in predicting cirrhosis (F≥5). Conclusions: As a result of this study, it has been determined that some noninvasive fibrosis markers can be used to predict liver fibrosis and necroinflammation levels, especially in chronic hepatitis B patients in resource- limited regions, in correlation with many studies in the literature. In addition, it was thought that the use of markers with high diagnostic accuracy could reduce the unnecessary biopsy procedures and the morbidity and mortality rates caused by this globally. However, despite all the findings, it should be kept in mind that biopsy is still the gold standard method for demonstrating liver fibrosis and necroinflammation. KEYWORDS: Noninvasive Fibrosis Markers, Chronic Hepatitis B, Liver Biopsy, Liver Fibrosis