EXPRESS: Predictors for Significant Hepatic Fibrosis in Chronic HBV Patients in Daily Clinical Practice: A Prospective Study.

Abstract

Accurate knowledge of fibrosis levels is essential for effective treatment decisions and prognostication in chronic hepatitis B (CHB) infection. Current guidelines recommend liver biopsy and elastography as the most reliable methods for assessing fibrosis in CHB patients. However, these methods are not widely implemented due to the limited availability, high costs, and invasiveness of liver biopsy. Thus, we aimed to identify simple clinical predictors of significant liver fibrosis in CHB patients in daily practice. We prospectively recruited CHB patients to undergo shear wave elastography (SWE), abdominal ultrasound, and blood tests. In parallel, we extracted data on patient demographics, habits, medical backgrounds, medications, and CHB status and treatment. Multivariate logistic regression analyses were used to determine predictors of significant fibrosis. Of the 173 patients included in the final analysis, 40 (23.0%) had evidence of significant fibrosis on two-dimensional SWE. Age> 50 years [odds ratio (OR): 3.53; 95% confidence interval (CI): 1.34-9.25; P= 0.001], alanine aminotransferase > 40 (OR: 8.16; 95%CI: 4.6-15.3; P= 0.001), hepatitis B virus DNA> 2000 (OR: 9.20; 95%CI: 3.4-19.0; P< 0.001), concomitant diabetes mellitus (OR: 3.58; 95%CI: 1.89-5.49; P= 0.040), moderate to severe steatosis on ultrasound (OR: 4.50; 95%CI: 2.35-9.95; P= 0.014), and heavy smoking were independent predictors of significant fibrosis. In conclusion, we identified clinical and laboratory variables that may effectively identify CHB patients at high risk of significant fibrosis. These can aid in resource allocation in daily practice with limited resources.