A Simple Noninvasive Model to Predict Significant Fibrosis in Children With Chronic Hepatitis B

Objectives: to develope a noninvasive model for significant fibrosis in children with chronic hepatitis B (CHB). Methods: : A total 116 CHB pediatric patients who had undergone liver biopsy were included in the study. Blood routine examination, coagulation function, liver biochemistry, viral serology and viral load were analyzed. Receiver operating characteristic (ROC) curve analysis was used to analyze sensitivity and specificity of all possible cut-off values. Results: : Based on the correlation and difference analysis, 7 available clinical parameters [Total bile acid (TBA), Gamma-glutamyl transpeptidase(GGT), Aspartate transaminase(AST), Direct bilirubin to total bilirubin ratio (D/T), Alanine aminotransferase(ALT), Prealbumin (PA),and Cholinesterase（CHE）] were included for modeling analysis. A model to predict significant liver fibrosis (Ishak fibrosis score ≥2) was derived using the two best parameters (PA and GGT) The original model was . After mathematical calculation, the G index 600×GGT/PA2 predicts significant fibrosis with an area under the receiving operating characteristics (AUROC) curve of 0.733，95% IC (0.643-0.811). The area under the receiver operating characteristic curve (AUROC) of G index (0.733,) was higher than that of APRI (0.680) and FIB-4(0.601) to predict significant fibrosis in children with CHB. If the G index's values outside 0.28-1.16, 52% of children with CHB could avoid liver biopsy with an overall accuracy of 75%. Conclusions: : The G index can predict and exclude significant fibrosis in children with HBV, which may reduce the liver biopsy need for children with CHB.