A noninvasive diagnostic model for significant liver fibrosis in patients with chronic hepatitis B based on CHI3L1 and routine clinical indicators

Abstract

Background: In consideration of the limitations of liver biopsy, the past years have seen a great advance in the application of noninvasive indices in assessing liver fibrosis. However, the accuracies of the existing indices to determine liver fibrosis in patients with chronic hepatitis B (CHB) are still unsatisfactory. Here, we established a noninvasive diagnostic model for assessing significant liver fibrosis (SLF) in CHB patients based on serum chitinase 3-like 1 (CH3L1) and routine clinical indicators.

Methods: The clinical data of 337 CHB patients treated at Xiamen Hospital of Traditional Chinese Medicine from December 1, 2019, to September 30, 2020, were collected in this cross-sectional study. All the enrolled cases were randomly divided into a training cohort (n=270) and a validation cohort (n=67). The training cohort was further divided into a non-significant liver fibrosis (NSLF) group (stages S0-S1; n=189; used as the control group) and an SLF group (stage S2-S4; n=81) based on the Scheuer scoring system. Univariate and multivariate logistic regression analyses were performed to screen for independent predictors of SLF in CHB patients and to establish a diagnostic model.

Results: The results of univariate and multivariate logistic regression analysis showed that CHI3L1, AFP and PLT were independent predictors of SLF in CHB patients, and the diagnostic model was established as follows: CHI3L1/AFP/PLT (CAP) = 0.600 × CHI3L1/upper limit of normal (ULN) + 0.252 × AFP/ULN - 1.424 × PLT/lower limit of normal (LLN) - 1.223. The area under the receiver operating characteristic (AUROC) of this model for the diagnosis of SLF in the training cohort and the validation cohort was 0.805 and 0.819, respectively, showing no statistically significant difference (P>0.05), and the AUROC for the diagnosis of SLF in the whole cohort was significantly higher than those of other noninvasive markers including aspartate transaminase to platelet ratio index (APRI), fibrosis 4 score (FIB-4) and CHI3L1 (all P<0.05).

Conclusions: The newly established model has a good diagnostic efficacy for SLF in CHB patients and is superior to other noninvasive markers including APRI, FIB-4, and CHI3L1. Thus, it can be used as a noninvasive diagnostic index for liver fibrosis in CHB patients.

Keywords: Chronic hepatitis B; chitosanase 3-like protein 1; liver fibrosis; noninvasive diagnosis.