Assessment of the extent of
liver fibrosis is a crucial requirement for the design of
antiviral treatments for patients with
chronic hepatitis B (CHB). Several non-invasive predictive indices have been developed as potential alternatives to liver biopsy for
fibrosis assessment. The present study aimed to establish a novel non-invasive method for predicting
liver fibrosis in patients with CHB. A total of 382 patients with CHB who underwent liver biopsy and pathological examination at The Second Hospital of Anhui Medical University (Hefei, China) were enrolled into the present study.
Liver fibrosis was assessed according to the meta-analysis of histological data in viral
hepatitis scoring system. Logistic regression analyses were performed to explore possibly significant characteristics associated with
liver fibrosis. In addition, potential correlations between the
alkaline phosphatase (AKP)-to-platelet count (PLT) ratio (APPR) and the
aspartate transaminase-to-platelet ratio index (APRI),
fibrosis index based on four factors (FIB-4) and γ-
glutamyl transpeptidase-to-platelet ratio (GPR) were assessed using Spearman's correlation analysis. Subsequently, the performance of APPR was compared with APRI, FIB-4 and GPR using receiver operating characteristic (ROC) analysis. Logistic regression analysis identified AKP and PLT to be significant independent predictors of
fibrosis. Therefore, an index was then constructed for predicting the degree of
fibrosis, which was expressed using the formula APPR=AKP (IU/ml)/PLT (1x109/l). APPR was found to be positively associated with the fibrotic stage of the liver in addition to being positively correlated with APRI, FIB-4 and GPR. The area under the ROC curve (AUROC) values of APPR were also significantly higher compared with those of APRI and FIB-4 in predicting significant
fibrosis but were equal to those of GPR. However, for advanced
fibrosis and
cirrhosis, the AUROC value of APPR was shown to be higher compared with that of APRI, FIB-4 and GPR. In conclusion, these observations suggest that APPR is a viable marker that can be used to assess
liver fibrosis in patients with CHB.