Liver stiffness in the hepatitis B virus carrier: A non-invasive marker of liver disease influenced by the pattern of transaminases

Table 1 Clinico-demographic characteristics of 268 chronic HBV carriers n (%)

	Chronic HBV carriers (n = 268)	Untreated HBV carriers (n = 188)	Treated HBV carriers (n = 80)
Age (yr)	48.2 ± 12.2	46.0 ± 11.8	53.3 ± 11.8
Male/Female	180/88	120/68	60/20
HBeAg/anti-HBe	31/237	22/166	9/71
Alcohol intake > 60 g/d	23 (8.6)	14 (7.4)	9 (11.3)
Diabetes	12 (4.5)	7 (3.7)	5 (6.3)
Hyperlipaemia	38 (14.2)	34 (18.1)	4 (5.0)
BMI
25-30 kg/m2	95 (35.4)	67 (35.6)	28 (35.0)
> 30 kg/m2	7 (2.6)	6 (3.2)	1 (1.3)
ALT > 300 IU/L	11 (4.1)	9 (4.8)	3 (3.8)
HBV-DNA (Log10 IU/mL)	4.70 ± 2.17	4.97 ± 2.17	4.06 ± 2.05
Inactive carriers	68 (25.4)	68 (36.2)	-
CHB Ishak score
S0-S2	85 (31.7)	71 (37.8)	14 (17.5)
S3-S4	19 (7.1)	12 (6.4)	7 (8.7)
S5-S6	30 (11.2)	14 (7.4)	16 (20.0)
US cirrhosis	66 (24.6)	23 (12.2)	43 (53.8)

US cirrhosis: Ultrasound signs of cirrhosis.

Table 2 Correlation between phase of infection, stage of liver disease and liver stiffness values

	n	Fibroscan values (kPa)
Blood donors	50	4.6 ± 1.2
Acute Hepatitis1	9	12.3 ± 3.3
Untreated HBsAg carriers overall1	188	8.9 ± 8.0
Inactive carriers whithout LD2	51	4.3 ± 1.0
Inactive carriers whit LD2	17	6.9 ± 2.3
CHB S0-S2	71	6.4 ± 2.4
CHB S3-S4	12	10.1 ± 3.8
CHB S5-S6	14	15.7 ± 9.0
US Cirrhosis3	23	23.6 ± 11.8
Treated CHB overall1	80	13.4 ± 9.7
CHB S0-S2	14	6.1 ± 1.7
CHB S3-S4	7	8.5 ± 2.8
CHB S5-S6	16	11.7 ± 5.2
US Cirrhosis3	43	17.2 ± 11.4

LD: Liver disease.

¹P < 0.001;

²P < 0.001;

³P = 0.035.

Table 3 Factors associated with FS values at uni and multivariate analysis in 171 chronic HBV carriers

Variable		Univariate analysis	Multivariate analysis
		P	B	95% CI	P
Age	yr	0.006			NS
Sex	Male	0.002			NS
Phase of infection1	CHB	< 0.001	-9.939	-12.989-6.889	< 0.001
Alcohol introduction	> 60 g/d	0.076			NS
Diabetes	Present	NS
Hyperlipemia	Present	0.089			NS
BMI	> 25 kg/m2	< 0.001			NS
ALT	Log10 IU/mL	< 0.001	5.713	3.333-8.094	< 0.001
Biochemical remission2	Present	< 0.001			NS
HBV-DNA serum levels	Log10 IU/mL	0.051	-0.470	-0.924/-0.016	0.042
Disease stage3	Class	< 0.001	5.021	4.269-5.773	< 0.001

¹CHB patients vs inactive carriers;

²Biochemical remission means normal ALT ≥ 12 mo;

³Inactive carriers, CHB S0-S2, S3-S4, S5-S6, US cirrhosis. NS: No significance.

Table 4 Factors associated with FS values at uni and multivariate analysis in 83 untreated non-cirrhotic CHB patients

Variable		Univariate analysis	Multivariate analysis
		P	B	95% CI	P
Age	yr	NS
Sex	Male	0.062			NS
Alcohol introduction	>60 g/d	NS
Diabetes	Present	NS
Hyperlipemia	Present	NS
BMI	> 25 kg/m2	NS
ALT	Log10 IU/mL	< 0.001	3.028	1.408-5.008	0.001
Biochemical remission	Present	0.017			NS
HBV-DNA serum levels	Log10 IU/mL	0.075			NS
Necroinflammation score	≥ 10/18	< 0.001	1.611	0.117-3.104	0.035
Disease stage1	S3-S4	< 0.001	3.054	1.318-4.789	0.001

¹CHB S0-S2 vs S3-S4; NS: No significance.

Table 5 Factors associated with FS values at uni and multivariate analysis in 80 treated CHB patients

Variable		Univariate analysis	Multivariate analysis
		P	B	95% CI	P
Age	yr	NS
Sex	Male	NS
Alcohol introduction	> 60 g/d	NS
Diabetes	Present	NS
Hyperlipaemia	Present	NS
BMI	> 25 kg/m2	NS
ALT	Log10 IU/mL	NS
Biochemical remission	Present	0.001	8.705	5.277-12.133	< 0.001
HBV-DNA serum levels	Log10 IU/mL	NS
Disease stage1	Class	< 0.001	4.374	2.982-5.766	< 0.001

¹CHB S0-S2, S3-S4, S5-S6, US cirrhosis. NS: No significance.

Table 6 Diagnostic performance of FS for identification of fibrosis ≥ S3 and cirrhosis by using the cut-offs of 7.5 kPa and 11.8 kPa

	Fibrosis stage≥S3		Fibrosis S5-S6/US cirrhosis
	IC + UT CHB	T CHB	IC + UT CHB	T CHB
Sensitivity (%)	93.9	78.8	86.5	54.2
Specificity (%)	88.5	71.4	96.3	90.5
Positive predictive value (%)	76.7	92.9	86.5	94.1
Negative predictive value (%)	97.3	41.7	96.3	41.3
Diagnostic accuracy (%)	90.1	77.5	94.2	63.8
Likelihood ratio for pos. test	8.18	2.76	23.18	5.69
Likelihood ratio for neg. test	0.07	0.30	0.14	0.51

IC + UT CHB: Inactive carriers + untreated CHB (171 patients); T CHB: Treated chronic hepatitis B (80 patients).