Liver stiffness-based composite indices for compensated and decompensated cirrhosis in chronic hepatitis B

Table 1 Baseline characteristics of chronic hepatitis B virus-infected patients by disease stage

Indicator	Chronic HBV infection group (n = 33)		CHB group (n = 49)	Compensated liver cirrhosis group (n = 27)	Decompensated liver cirrhosis group (n = 23)	P value
Age (years)	Median (IQR)	46 (22.50)	37 (19.50)	52 (23.00)	56 (8.00)	< 0.001
Height (m)	Median (IQR)	1.67 (0.11)	1.70 (0.14)	1.70 (0.13)	1.65 (0.14)	0.054
Weight (kg)	mean ± SD	66.06 ± 10.85	69.62 ± 14.72	71.76 ± 14.86	67.24 ± 14.21	0.438
BMI (kg/m2)	mean ± SD	24.12 ± 3.88	24.39 ± 4.24	24.86 ± 4.10	24.72 ± 3.69	0.718
ALT (IU/L)	Median (IQR)	20.50 (12.00)	126.30 (263.90)	36.90 (31.70)	26.80 (16.10)	< 0.001
AST (IU/L)	Median (IQR)	22.50 (7.15)	80.00 (99.15)	35.30 (27.10)	35.30 (37.30)	< 0.001
ALP (IU/L)	Median (IQR)	76.50 (34.40)	97.50 (53.50)	89.00 (31.40)	78.30 (57.40)	0.009
GGT (IU/L)	Median (IQR)	18.20 (13.35)	95.60 (124.75)	35.40 (48.90)	24.40 (58.70)	< 0.001
TBA (µmol/L)	Median (IQR)	3.70 (5.60)	5.50 (11.70)	10.30 (22.20)	12.30 (42.90)	0.001
T-Bil (µmol/L)	Median (IQR)	12.60 (7.60)	18.60 (13.65)	20.60 (15.40)	21.70 (20.00)	< 0.001
D-Bil (µmol/L)	Median (IQR)	2.80 (1.45)	4.40 (4.25)	5.10 (3.30)	5.10 (3.80)	< 0.001
I-Bil (µmol/L)	Median (IQR)	9.70 (6.25)	14.60 (10.20)	15.30 (12.30)	16.10 (16.50)	0.001
TC (mmol/L)	Median (IQR)	4.39 (1.28)	4.14 (1.41)	3.74 (1.27)	3.13 (1.44)	0.002
TG (mmol/L)	Median (IQR)	0.93 (0.71)	1.27 (0.99)	0.93 (0.34)	0.77 (0.50)	0.001
ALB (g/L)	Median (IQR)	43.30 (5.75)	41.90 (5.65)	38.60 (8.00)	34.30 (9.50)	< 0.001
PLT (109/L)	mean ± SD	193.52 ± 61.26	170.22 ± 61.06	116.37 ± 55.54	80.00 ± 48.25	< 0.001
PT (seconds)	Median (IQR)	11.30 (1.00)	11.60 (1.60)	12.30 (2.50)	13.20 (2.20)	< 0.001
PTA (%)	mean ± SD	95.61 ± 10.23	92.24 ± 16.05	80.22 ± 15.72	73.83 ± 15.24	< 0.001
LSM (KPa)	Median (IQR)	5.00 (1.70)	8.40 (8.15)	13.30 (15.90)	16.60 (19.00)	< 0.001
CAP (dB/m)	Median (IQR)	216.00 (51.50)	222.00 (76.50)	222.00 (78.00)	208.00 (52.00)	0.466
Gender	Male, n (%)	16 (48.48)	35 (71.43)	20 (74.07)	11 (47.83)	0.045
	Female, n (%)	17 (51.52)	14 (28.57)	7 (25.93)	12 (52.17)

CHB: Chronic hepatitis B; HBV: Hepatitis B virus; BMI: Body mass index; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; TBA: Total bile acid; T-Bil: Total bilirubin; D-Bil: Direct bilirubin; I-Bil: Indirect bilirubin; TC: Total cholesterol; TG: Triglyceride; ALB: Albumin; PLT: Platelet count; PT: Prothrombin time; PTA: Prothrombin activity; LSM: Liver stiffness measurement; CAP: Controlled attenuation parameter; IQR: Inter-quartile range.

Table 2 Logistic regression estimates for predicting chronic hepatitis B

Variable	β	SE	χ2	P value	OR	95%CI
						Low	Up
β0	31.517	32.736	0.927	0.336
Male	0.131	1.340	0.009	0.922	1.140	0.082	15.754
Age	0.004	0.051	0.006	0.939	1.004	0.909	1.109
ALT	0.101	0.046	4.861	0.027	1.106	1.011	1.210
AST	0.070	0.057	1.505	0.220	1.073	0.959	1.200
ALP	0.000	0.022	0.000	0.997	1.000	0.957	1.045
GGT	0.011	0.021	0.262	0.609	1.011	0.969	1.054
TBA	-0.014	0.069	0.039	0.843	0.986	0.862	1.129
T-Bil	0.120	0.110	1.184	0.277	1.127	0.908	1.399
TC	1.514	0.863	3.080	0.079	4.546	0.838	24.662
TG	0.071	0.676	0.011	0.917	1.073	0.286	4.035
ALB	-0.045	0.100	0.208	0.648	0.956	0.786	1.161
PLT	-0.019	0.014	1.751	0.186	0.981	0.954	1.009
PT	-2.176	1.831	1.411	0.235	0.114	0.003	4.111
PTA	-0.189	0.124	2.313	0.128	0.828	0.650	1.056
LSM	0.223	0.183	1.483	0.223	1.250	0.873	1.790

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; TBA: Total bile acid; T-Bil: Total bilirubin; TC: Total cholesterol; TG: Triglyceride; ALB: Albumin; PLT: Platelet count; PT: Prothrombin time; PTA: Prothrombin activity; LSM: Liver stiffness measurement; OR: Odds ratio; CI: Confidence interval.

Table 3 Logistic regression estimates for predicting compensated hepatitis B virus-related cirrhosis

Variable	β	SE	χ2	P value	OR	95%CI
						Low	Up
β0	23.846	32.121	0.551	0.458
Male	-2.732	1.314	4.320	0.038	0.065	0.005	0.856
Age	0.125	0.047	7.022	0.008	1.133	1.033	1.243
ALT	0.098	0.047	4.329	0.037	1.102	1.006	1.208
AST	0.072	0.058	1.506	0.220	1.074	0.958	1.204
ALP	0.004	0.022	0.040	0.841	1.004	0.961	1.050
GGT	-0.037	0.022	2.828	0.093	0.963	0.922	1.006
TBA	-0.005	0.068	0.005	0.943	0.995	0.871	1.137
T-Bil	0.084	0.110	0.587	0.444	1.088	0.877	1.349
TC	1.813	0.858	4.463	0.035	6.129	1.140	32.956
TG	-0.521	0.767	0.460	0.497	0.594	0.132	2.673
ALB	0.009	0.101	0.008	0.928	1.009	0.828	1.230
PLT	-0.039	0.015	7.066	0.008	0.962	0.934	0.990
PT	-2.043	1.752	1.359	0.244	0.130	0.004	4.021
PTA	-0.176	0.125	1.974	0.160	0.838	0.656	1.072
LSM	0.518	0.184	7.953	0.005	1.679	1.171	2.407

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; TBA: Total bile acid; T-Bil: Total bilirubin; TC: Total cholesterol; TG: Triglyceride; ALB: Albumin; PLT: Platelet count; PT: Prothrombin time; PTA: Prothrombin activity; LSM: Liver stiffness measurement; OR: Odds ratio; CI: Confidence interval.

Table 4 Logistic regression estimates for predicting decompensated hepatitis B virus-related cirrhosis

Variable	β	SE	χ2	P value	OR	95%CI
						Low	Up
β0	32.084	33.010	0.945	0.331
Male	-1.826	1.404	1.690	0.194	0.161	0.010	2.525
Age	0.204	0.067	9.180	0.002	1.226	1.075	1.398
ALT	0.050	0.051	0.968	0.325	1.051	0.952	1.160
AST	0.108	0.058	3.493	0.062	1.114	0.995	1.248
ALP	-0.014	0.024	0.342	0.559	0.986	0.942	1.033
GGT	-0.033	0.024	1.852	0.174	0.968	0.924	1.014
TBA	-0.019	0.068	0.078	0.781	0.981	0.858	1.122
T-Bil	0.170	0.113	2.259	0.133	1.185	0.950	1.479
TC	2.188	0.920	5.662	0.017	8.922	1.471	54.111
TG	-1.521	1.384	1.208	0.272	0.218	0.014	3.293
ALB	-0.183	0.089	4.214	0.040	0.833	0.700	0.992
PLT	-0.050	0.018	7.653	0.006	0.951	0.918	0.985
PT	-2.217	1.778	1.555	0.212	0.109	0.003	3.552
PTA	-0.200	0.139	2.065	0.151	0.818	0.623	1.076
LSM	0.467	0.184	6.461	0.011	1.595	1.113	2.287

ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: γ-glutamyl transpeptidase; TBA: Total bile acid; T-Bil: Total bilirubin; TC: Total cholesterol; TG: Triglyceride; ALB: Albumin; PLT: Platelet count; PT: Prothrombin time; PTA: Prothrombin activity; LSM: Liver stiffness measurement; OR: Odds ratio; CI: Confidence interval.

Table 5 Diagnostic performance of the proposed models and established indices for chronic hepatitis B, compensated cirrhosis, and decompensated cirrhosis

Disease	Model	Cut-off value	Sensitivity	Specificity	AUC	95%CI
CHB	A-index	> 4.60	0.86	1.00	0.948	0.900-0.997
	ALBI grade	> -2.85	0.69	0.61	0.656	0.534-0.778
Compensated liver cirrhosis	MAPTAL index	> 12.76	0.81	0.88	0.918	0.853-0.983
	APRI	> 0.56	0.70	0.94	0.895	0.818-0.972
	LPRI	> 4.32	0.93	0.85	0.942	0.887-0.997
	Fib-4 index	> 2.31	0.70	0.88	0.838	0.735-0.941
	S index	> 0.11	0.78	0.82	0.854	0.758-0.949
Decompensated liver cirrhosis	APTAL index	> 11.39	0.87	0.94	0.968	0.930-1.007
	APRI	> 0.45	0.91	0.88	0.929	0.855-1.002
	LPRI	> 4.85	0.96	0.88	0.949	0.873-1.024
	Fib-4 index	> 3.76	0.74	0.97	0.938	0.880-0.996
	S index	> 0.11	0.83	0.82	0.877	0.780-0.974

A-index = 0.101 × alanine aminotransferase (ALT); MAPTAL index = -2.732 × male + 0.125 × age - 0.039 × platelet count (PLT) + 1.813 × total cholesterol (TC) + 0.098 × ALT + 0.518 × liver stiffness measurement (LSM); APTAL index = 0.204 × age - 0.05 × PLT + 2.188 × TC - 0.183 × albumin + 0.467 × LSM. CHB: Chronic hepatitis B; ALBI grade: Albumin-bilirubin grade; APRI: Aspartate Platelet Ratio Index; LPRI: LSM to Platelet Ratio Index; Fib-4: Fibrosis-4; AUC: Area under the curve; CI: Confidence interval.