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Chang X, Wang J, Chen Y, Long Q, Song L, Li Q, Liu H, Shang Q, Yu Z, Jiang L, Xiao G, Li L, Chen L, Wang X, Li Z, Chen D, Dong Z, An L, Tan L, Chen Y, Yang Y. A novel nomogram to predict evident histological liver injury in patients with HBeAg-positive chronic hepatitis B virus infection. EBioMedicine 2021; 67:103389. [PMID: 34004423 PMCID: PMC8141676 DOI: 10.1016/j.ebiom.2021.103389] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 12/14/2022] Open
Abstract
Background HBeAg-positive chronic infection is a unique phase of chronic hepatitis B virus (HBV) infection. Current guidelines advise against starting antiviral treatment for HBeAg-positive chronic hepatitis B virus (HBV) infection patients, some data suggest treating such patients may reduce the risk of hepatocellular carcinoma. We aimed to explore whether these patients can have evident histological liver injury (EHLI), and develop a non-invasive model for identifying EHLI in such patients. Method We assessed whether HBeAg-positive chronic HBV infection patients can have EHLI defined by Ishak fibrosis stage ≥3 and/or histologic activity index ≥ 9 in a prospective multicenter study. Logistic and Lasso regression was used to select the optimal predictors. We used Akaike information criterion, discrimination improvement, net reclassification improvement to develop and validate models predicting EHLI risk in training cohort and two external validation cohorts. Findings Of these 336 patients met the inclusion criteria, 181(54%) were HBeAg-positive chronic HBV infection, of whom 60 patients (33%) had EHLI, the proportion of significant fibrosis was higher than that of significant inflammation (33% vs. 8%, P < 0.001). Age, liver stiffness measurement, ALT, alkaline phosphatase, and albumin were identified as independent predictors for EHLI and used to develop a nomogram that have been demonstrated having a good performance in predicting EHLI with AUROCs of 0.92(95%CI: 0.86–0.99) in the training cohort (n = 233) and 0.90(95%CI: 0.84–0.95) in validation cohort 1(n = 103), significant correcting current guidelines recommendations overestimating insignificant or significant histological disease. After 72-weeks entecavir treatment for HBeAg-positive chronic HBV infection patients with EHLI identified by nomogram, histological improvement occurred in 40 of 49(82%), 38(78%) had fibrosis reversal, and 35(73%) no longer had EHLI. Interpretation In HBeAg-positive chronic HBV infection patients, 33% has EHLI. The nomogram developed in this study can accurately identify HBeAg-positive chronic HBV infection patients with EHLI, and that responded very well to antiviral therapy. Funding This study was funded by the State Key Projects Specialized on Infectious Disease, Chinese Ministry of science and technology (2013ZX10005002; 2018ZX10725506), National Natural Science Foundation of China (81970525) and Beijing Key Research Project of Special Clinical Application (Z151100004015221).
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Affiliation(s)
- Xiujuan Chang
- Department of Liver Disease, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Jing Wang
- Affiliated Traditional Chinese Medicine Hospital of Southwest Medical University, Luzhou, Sichuan 610072, China
| | - Yan Chen
- Department of Liver Disease, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Qinghua Long
- Department of Infection and Liver Disease, Yichun People's Hospital, Yichun, Jiangxi, China
| | - Laicheng Song
- Taihe Traditional Chinese Medicine Hospital, Taihe, Anhui 400038, China
| | - Qin Li
- Fuzhou Infectious Diseases Hospital, Fuzhou, Fujian 350025, China
| | - Huabao Liu
- Traditional Chinese Medicine Hospital of Chongqing, Chongqing 400038, China
| | - Qinghua Shang
- Center of Therapeutic Liver Disease, The 960th Hospital of Chinese PLA, Taian, Shandong 271000, China
| | - Zujiang Yu
- Department of Infectious Disease, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Li Jiang
- Department of Infectious Diseases, Southwest Hospital, Army Military Medical University, Chongqing 400038, China
| | - Guangming Xiao
- Guangzhou 8th People's Hospital, Guangzhou, Guangdong 510060, China
| | - Li Li
- Department of Traditional Chinese Medicine, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - Liang Chen
- Department of Hepatic Diseases, Shanghai Public Health Clinical Center, Shanghai 201508, China
| | - Xiaodong Wang
- Department of Infectious and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zhiqin Li
- Department of Infectious Disease, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China
| | - Da Chen
- Department of Infectious and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China
| | - Zheng Dong
- Department of Liver Disease, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Linjing An
- Department of Liver Disease, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China
| | - Lin Tan
- Department of Liver Disease, Fuyang 2nd People's Hospital, Fuyang, Anhui 236015, China.
| | - Yongping Chen
- Department of Infectious and Liver Diseases, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China.
| | - Yongping Yang
- Department of Liver Disease, the Fifth Medical Center of Chinese PLA General Hospital, Beijing 100039, China.
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