225 Diagnosis of hepatic steatosis and fibrosis by transient elastography in asymptomatic healthy people: A prospective study in potential living related liver donors

Background and Aims: To be practically used at bedside, simple noninvasive models to predict liver fibrosis have been evaluated in chronic hepatitis C, not B.However, clinical features of fibrosis progression were suggested to be different in patients with hepatitis B virus (HBV) infection.The aim of current study is to compare and validate the diagnostic accuracies of simple non-invasive models in population with HBV infection.Methods: A total of 362 patients (310 males, mean age 34• years) with pathologically confirmed HBV infection were enrolled.METAVIR liver fibrosis stages were assessed on liver specimens, and significant fibrosis was defined as stage 3 or more.The aspartate to alanine aminotransferase (AST to ALT) ratio (AAR), age-platelet index (API), AST to platelet ratio index (APRI), reported to predict significant fibrosis in previous studies, and spleen size to platelet ratio index (SPRI) were compared.SPRI is a proposed new model which reflects thrombocytopenia due to secondary hypersplenism.The receiver operating characteristic (ROC) was used for the analysis.Results: METAVIR fibrosis stages were FOFl n 88, F2n 121, F3n 74 and F4 n 79.API, SPRI, APRI, AAR were significantly correlated with the fibrosis stage evaluated by METAVIR (Spearman's rho, r 0.61, 0.50, 0.49, and 0.22, respectively, p < 0.001).ROC curve analysis showed comparable diagnostic accuracies of API, SPRI, APRI and AAR for significant fibrosis (area under the curve [AUROC] 0.816, 0.777, 0.707, 0.634, respectively).The positive predictive values (PPV) of SPRI (~>9), API (~>6), APRI (~>1.5) and AAR (~>1.5) for significant fibrosis were 91.3%, 84.4%, 80% and 71.4%, respectively.SPRI was the most useful model due to its highest PPV, reducing the need of liver biopsy.Conclusions: Previously reported simple non-invasive models were correlated to the stages of liver fibrosis in patients with HBV infection.Among them, SPRI was the most simple and useful index to detect significant liver fibrosis without liver biopsy.The diagnosis and follow-up using SPRI could be of interest and should be further evaluated.