Diagnostic efficacy and influencing factors of non-invasive liver fibrosis scores in chronic hepatitis B fibrosis: Cross-sectional study

doi:10.4254/wjh.v18.i5.116008

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 18, Issue 5

This Article

(13)

(10)

(0)

(29)

(221)

Peer-Review Report of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Journal Information of This Article

Publication Name

World Journal of Hepatology

ISSN

1948-5182

Publisher of This Article

Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Observational Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Hepatol. May 27, 2026; 18(5): 116008
Published online May 27, 2026. doi: 10.4254/wjh.v18.i5.116008

Diagnostic efficacy and influencing factors of non-invasive liver fibrosis scores in chronic hepatitis B fibrosis: Cross-sectional study

Da-Feng Liu, Mao-Quan Li, Jun Kang, Ben-Nan Zhao, Li-Juan Lan, Pan Yan, Chun-Xia Wang

Chun-Xia Wang, Pan Yan, Mao-Quan Li, School of Public Health, Chengdu Medical College, Chengdu 610500, Sichuan Province, China

Li-Juan Lan, Ben-Nan Zhao, Jun Kang, Da-Feng Liu, The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, Chengdu 610066, Sichuan Province, China

Mao-Quan Li, Office of the Party Committee, Neijiang Health Vocational College, Neijiang 641100, Sichuan Province, China

Mao-Quan Li, Sichuan Provincial Key Laboratory of Philosophy and Social Sciences for Intelligent Medical Care and Elderly Health Management, Chengdu 610500, Sichuan Province, China

Co-first authors: Chun-Xia Wang and Pan Yan.

Co-corresponding authors: Mao-Quan Li and Da-Feng Liu.

Author contributions: Wang CX, Liu DF, and Li MQ were responsible for the conception and design of the study and its overall research framework; Li MQ and Liu DF supervised the entire research process; as joint corresponding authors, they bear equal accountability in this capacity; Wang CX, Yan P, Zhao BN, Lan LJ, and Kang J conducted patient screening and collected clinical data from participants; Wang CX, Yan P, Liu DF, Li MQ, Zhao BN, Lan LJ, and Kang J performed the data analysis; Wang CX, Yan P, Liu DF, and Li MQ drafted the manuscript; all authors reviewed the complete draft of the manuscript and approved its final version. Yan P was responsible for patient screening, clinical data collection, statistical analysis, and manuscript drafting, and made crucial and indispensable contributions to the completion of the project, thereby qualifying as a joint first author of the manuscript. As joint corresponding authors, both Li MQ and Liu DF played an important and indispensable role in study design, data interpretation and manuscript preparation. The funding for this research project was applied for and obtained by Liu DF. She conceived, designed, and supervised the entire project, conducted literature reviews, and revised and submitted early versions of the manuscript, with a focused emphasis on the academic normativity of the study and the rigor of its research conclusions. As a joint corresponding author, Li MQ fulfilled the corresponding author responsibilities in collaboration with Liu DF and shared equal accountability. He played an indispensable core role in the advancement of the project: He was deeply involved in the refinement and optimization of the research protocol, guided the research direction by virtue of his academic expertise, and ensured the scientificity and feasibility of the study design; meanwhile, he participated in literature investigation and collation, and provided key guidance on the in-depth interpretation of research data and the precise refinement of research conclusions. In the process of manuscript drafting and revision, he conducted a rigorous review of the academic logic, data authenticity and expression normativity of the manuscript, collaborated with Liu DF to complete the revision and improvement of the manuscript and the final validation of its final version, and actively participated in academic coordination and quality control throughout the research process. Together with Liu DF, he ensured the smooth implementation of the project and the academic value of the research outcomes.

Supported by Scientific Research Project of Sichuan Provincial Medical Association, No. S2024026; the Sichuan Traditional Chinese Medicine Administration Research Program, No. 2024MS147; and the Open Fund of Sichuan Provincial Key Laboratory of Philosophy and Social Sciences for Intelligent Medical Care and Elderly Health Management, No. ZHYYZKZD2401.

Institutional review board statement: This study was carried out in line with the ethical guidelines outlined in the Declaration of Helsinki (issued by the World Medical Association; accessible at: https://www.wma.net/policies-post/wma-declaration-of-helsinki/). The study was reviewed and approved by the Chengdu Public Health Clinical Medical Center Ethics Committee (Approval No. YJ-K2025-87-01).

Informed consent statement: The retrospective design of this study, combined with the use of de-identified patient data and the prior provision of comprehensive verbal and written explanations concerning the study’s objectives and potential implications to all participants, led the institutional review board (IRB) or local ethics committee to grant an exemption from the requirement for written informed consent from the participants themselves or their legal representatives/next of kin. This research was conducted in full compliance with applicable local legislative regulations and the specific requirements of the hosting institution.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: All data, analytical models, and code produced or employed in this study can be obtained from the study’s corresponding author when a reasonable request is made. For inquiries, please reach out to: Da-Feng Liu, E-mail address: ldf312@126.com.

Corresponding author: Da-Feng Liu, Professor, The First Ward of Internal Medicine, Public Health Clinical Center of Chengdu, No. 377 Jingming Road, Jinjiang District, Chengdu 610066, Sichuan Province, China. ldf312@126.com

Received: October 31, 2025
Revised: December 23, 2025
Accepted: February 6, 2026
Published online: May 27, 2026
Processing time: 207 Days and 12.8 Hours

Abstract

BACKGROUND

During the pathological advancement of chronic hepatitis B (CHB) toward cirrhosis and hepatocellular carcinoma, liver fibrosis acts as a pivotal transitional phase. Currently, non-invasive diagnostic techniques have become key substitutes for liver biopsy. However, the diagnostic efficacy of different indicators varies across populations, and the influence of factors such as gender, nutritional status, and liver function reserve remains unclear, necessitating further clarification.

AIM

To evaluate the diagnostic performance of serological indicators, including the aspartate transaminase to platelet ratio index (APRI), the fibrosis-4 index (FIB-4), the gamma-glutamyl transferase to platelet ratio (GPR), and the aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), with liver stiffness measurement (LSM) via FibroScan as a reference, and to investigate the influence of gender, nutritional status, and Child-Pugh classification on these serum assessment indicators.

METHODS

For this cross-sectional investigation, 627 CHB cases were consecutively enrolled at Chengdu Public Health Clinical Medical Center during the four-year interval from December 2020 to December 2024. Extensive data collection incorporated FibroScan-derived LSM alongside four well-validated serum fibrosis indices: APRI, FIB-4, GPR, and AST/ALT. Associations between these serum-derived indices and different fibrosis stages were examined; the effects of gender, nutritional status, and Child-Pugh class on the diagnostic performance of these non-invasive scoring tools were also assessed.

RESULTS

The median age of CHB participants was 47 years, with male patients comprising 69.86% (438/627). Spearman correlation testing revealed that all non-invasive liver fibrosis assessment indices showed robust associations with FibroScan-measured LSM values and FibroScan-derived liver fibrosis staging (P < 0.001); notably, the correlation between GPR and both LSM values and fibrosis staging was the most pronounced (r = 0.609). Univariate statistical analyses revealed significant disparities across the nutritional risk subgroup, the Child-Pugh staging subgroup, and each of the assessed indices (P < 0.001). Meanwhile, multivariable regression modeling showed that the GPR exhibited the most favorable diagnostic efficacy for two fibrosis categories: “Any fibrosis (F1-F4)” and “significant fibrosis (F3-F4)”. For the GPR model, the area under the curve (AUC) values were 0.816 [95% confidence interval (CI): 0.779-0.853] and 0.871 (95%CI: 0.844-0.899), with both outcomes corresponding to P values < 0.001. Analysis of receiver operating characteristic curves demonstrated that the GPR exhibited strong performance in identifying significant fibrosis: it achieved an AUC of 0.828 (95%CI: 0.796-0.860), alongside 87.6% sensitivity and 64.4% specificity. Moreover, the FIB-4 index demonstrated robust diagnostic performance (AUC = 0.814), surpassing that of both APRI and the AST/ALT ratio.

CONCLUSION

GPR and FIB-4 function as valid serological assessment indicators for identifying liver fibrosis in patients with CHB, especially in instances of advanced fibrosis and cirrhotic stages. In clinical settings, a holistic evaluation of liver fibrosis is recommended by incorporating the patient’s gender, nutritional status, and liver functional reserve to enhance diagnostic precision.

Keywords: Chronic hepatitis B; Gamma-glutamyl transferase to platelet ratio; Fibrosis-4 index; Aspartate aminotransferase to platelet ratio index; Aspartate transaminase to alanine aminotransferase ratio; Child-Pugh classification; Nutritional risk

Core Tip: This investigation was carried out in Southwest China, where the diagnostic efficacy of four non-invasive liver fibrosis scoring tools [aspartate transaminase to platelet ratio index, fibrosis-4 index (FIB-4), gamma-glutamyl transferase to platelet ratio (GPR), and aspartate aminotransferase to alanine aminotransferase ratio] was comprehensively assessed. The results indicated that GPR and FIB-4 achieved optimal diagnostic precision for detecting significant fibrosis and cirrhosis; notably, GPR demonstrated the strongest association with FibroScan-derived liver stiffness measurements. Furthermore, the study revealed that diagnostic performance is influenced by gender, nutritional status, and Child-Pugh grade. These findings indicate that incorporating GPR and FIB-4 into routine clinical assessment, along with patient-specific characteristics, can improve early screening for liver fibrosis in chronic hepatitis B.