Globulin-platelet model predicts significant fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase levels.

The globulin-platelet model (GP) is a new noninvasive liver fibrosis model developed in chronic hepatitis B (CHB) patients. This study aimed to evaluate the diagnostic performance of GP model for liver fibrosis and cirrhosis in CHB patients with high HBV DNA and mildly elevated alanine transaminase (ALT) levels. We enrolled 316 CHB patients with HBV DNA ≥ 4 log 10 copies/mL and 40 IU/L < ALT ≤ 80 IU/L. The GP, aspartate transaminase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) were calculated. Using liver histology as a gold standard, the diagnostic performances of noninvasive fibrosis models were compared by the area under receiver operating characteristic curves (AUROCs). Of 316 patients, 146 (46.2%), 64 (20.3%) and 40 (12.7%) were classified as having significant fibrosis, severe fibrosis and cirrhosis, respectively. To predict significant fibrosis, the AUROC of GP was lower than APRI (0.64 vs 0.76, p < 0.001) and equivalent to FIB-4 (0.64 vs 0.66, p = 0.366). To predict severe fibrosis, the AUROC of GP was equivalent to APRI (0.82 vs 0.79, p = 0.409) and FIB-4 (0.82 vs 0.77, p = 0.224). To predict cirrhosis, the AUROC of GP was higher than APRI (0.91 vs 0.84, p = 0.033) and FIB-4 (0.91 vs 0.80, p = 0.004). GP is a more accurate noninvasive fibrosis model than APRI and FIB-4 to diagnose cirrhosis in CHB patients with high HBV DNA and mildly elevated ALT levels. The clinical application of GP model may reduce the need for liver biopsy in CHB patients.