Lowering the threshold of alanine aminotransferase for enhanced identification of significant hepatic injury in chronic hepatitis B patients

Figure 1 Distribution and liver histological features of chronic hepatitis B patients in different immune states. A and D: Proportions of liver inflammation grades in different immune status groups; B and E: Proportions of fibrosis stages in different immune status groups; C and F: Proportions of significant hepatic injury in different immune status groups. A: HBeAg-positive chronic hepatitis B virus (HBV) infection; B: HBeAg-positive chronic hepatitis B; C: HBeAg-negative chronic HBV infection; D: HBeAg-negative chronic hepatitis B; GZ: Grey zone; EHI: Evidenced hepatic injury. ^aP < 0.001.

Figure 2 Multiple logistic regression analysis. A: Multiple logistic regression analysis of clinical parameters of chronic hepatitis B patients in HBeAg-positive grey zones associated with significant hepatic injury; B: Multiple logistic regression analysis of clinical parameters of chronic hepatitis B patients in HBeAg-negative grey zones associated with significant hepatic injury; C: Receiver operating characteristic (ROC) curves of aspartate aminotransferase-to-platelet ratio index (APRI), fibrosis score based on four factors (FIB-4), and gamma-glutamyl transpeptidase-to-platelet ratio (GPR) in the prediction of significant hepatic injury (SHI) in HBeAg-positive grey zones; D: ROC curves of APRI, FIB-4, and GPR in the prediction of SHI in HBeAg-negative grey zones. PLT: Platelet; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transpeptidase; ALB: Albumin; APRI: Aspartate aminotransferase-to-platelet ratio index; FIB-4: Fibrosis score based on four factors; GPR: Gamma-glutamyl transpeptidase-to-platelet ratio.

Figure 3 The alanine aminotransferase treatment threshold was lowered to the American Association for the Study of Liver Diseases 2018 treatment criteria (35 U/L for males and 25 U/L for females). A: Among the 794 chronic hepatitis B virus infections, 27.8% (221/794) of patients were above the American Association for the Study of Liver Diseases criteria; B: Comparison of the proportions of patients exceeding the alanine aminotransferase (ALT) threshold in different groups; C: A total of 43.1% (247/573) of patients below the ALT threshold had significant liver inflammation (≥ G2); D: The proportion of significant hepatic injury (SHI) in patients below the ALT threshold was 51.3%. Comparison of the proportions of SHI in each group. ALT: Alanine aminotransferase; NS: Not significant. ^aP < 0.05, ^bP < 0.01, ^cP < 0.001.

Figure 4 Lowering the alanine aminotransferase treatment threshold to new criteria (30 U/L for men and 19 U/L for women). A: Among the 794 chronic hepatitis B virus infections, 50.5% (401/794) of patients were above the new criteria; B: Comparison of the proportions of patients exceeding the alanine aminotransferase (ALT) threshold in different groups; C: A total of 41.7% (164/393) of patients below the ALT threshold had significant liver inflammation (≥ G2); D: The proportion of significant hepatic injury (SHI) in patients below the ALT threshold was 50.4%. Comparison of the proportions of SHI in each group. NS: Not significant. ^aP < 0.05, ^bP < 0.01, ^cP < 0.001.

Figure 5 Comparison in different groups. A: Comparison of age in different groups; B: Comparison of the proportions of patients older than 30 years in different groups; C: The proportion of significant hepatic injury (SHI) in patients ≤ 30 years of age was 49.1%. Comparison of the proportions of SHI in each group. NS: Not significant. ^aP < 0.05.