The gamma-glutamyl transpeptidase-to-platelet ratio predicts liver fibrosis and cirrhosis in HBeAg-positive chronic HBV infection patients with high HBV DNA and normal or mildly elevated alanine transaminase levels in China.

The gamma-glutamyl transpeptidase-to-platelet ratio (GPR) is a new serum diagnostic model, which is reported to be more accurate than aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on the four factors (Fib-4) for the diagnosis of significant fibrosis and cirrhosis in chronic HBV infection (CHBVI) patients in West Africa. To evaluate the performance of the GPR model for the diagnosis of liver fibrosis and cirrhosis in HBeAg-positive CHBVI patients with high HBV DNA (≥5 log10 copies/mL) and normal or mildly elevated alanine transaminase (ALT) (≤2 times upper limit of normal (ULN)) in China. A total of 1521 consecutive CHBVI patients who underwent liver biopsies and routine laboratory tests were retrospectively screened. Of these patients, 401 treatment naïve HBeAg-positive patients with HBV DNA≥5 log10 copies/mL and ALT≤2 ULN were included. The METAVIR scoring system was adopted as the pathological diagnosis standard of liver fibrosis. Using liver histology as a gold standard, the performances of GPR, APRI, and Fib-4 for the diagnosis of liver fibrosis and cirrhosis were evaluated and compared by receiver operating characteristic (ROC) curves and the area under the ROC curves (AUROCs). Of 401 patients, 121 (30.2%), 49 (12.2%) and 17 (4.2%) were classified as having significant fibrosis (≥F2), severe fibrosis (≥F3) and cirrhosis (=F4), respectively. After estimating the AUROC to predict significant fibrosis, the performance of GPR (AUROC=0.66, 95% CI 0.60-0.72) was higher than APRI (AUROC=0.58, 95% CI 0.52-0.64, P=.002) and Fib-4 scores (AUROC=0.54, 95% CI 0.47-0.60, P<.001). After estimating the AUROC to predict severe fibrosis, the performance of GPR (AUROC=0.71, 95% CI 0.63-0.80) was also higher than APRI (AUROC=0.65, 95% CI 0.56-0.73, P=.003) and Fib-4 scores (AUROC=0.67, 95% CI 0.58-0.75, P=.001). After estimating the AUROC to predict cirrhosis, the performance of GPR (AUROC=0.73, 95% CI 0.56-0.88) was higher than APRI (AUROC=0.69, 95% CI 0.54-0.83, P=.041) and Fib-4 scores (AUROC=0.69, 95% CI 0.55-0.82, P=.012) too. The GPR is a new serum model for the diagnosis of liver fibrosis and cirrhosis and shows obvious advantages in Chinese HBeAg-positive patients with HBV DNA≥5 log10 copies/mL and ALT≤2 ULN compared with APRI and Fib-4, thus warranting its widespread use for this specific population.