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Gut. 2016 Aug;65(8):1369-76. doi: 10.1136/gutjnl-2015-309260. Epub 2015 Jun 24.

The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa.

Author information

1
Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
2
The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia Emerging Disease Epidemilogy Unit, Institut Pasteur, Paris, France.
3
Department of Hepatology, Imperial College London, St Mary's Hospital, London, UK.
4
Department of Histopathology, Edward Francis Small Teaching Hospital, Banjul, The Gambia.
5
Centre for Pathology, Imperial College London, London, UK.
6
The Gambia Unit, Liver Unit, Medical Research Council, Fajara, The Gambia.
7
Ministry of Health and Social Welfare, Banjul, The Gambia.
8
Department of infectious disease, Imperial College London, St Mary's Hospital, London, UK.
9
Emerging Disease Epidemilogy Unit, Institut Pasteur, Paris, France.
10
Department of Hepatology and Gastroenterology, Principal Hospital, Dakar, Senegal.
11
Université Paris Descartes, APHP, Groupe Hospitalier Cochin Port Royal, Institut Pasteur, Paris, France.

Abstract

BACKGROUND:

Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa.

METHODS:

Using liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets).

RESULTS:

Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4.

CONCLUSIONS:

The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.

KEYWORDS:

FIBROSIS; HEPATITIS B

PMID:
26109530
PMCID:
PMC4975834
DOI:
10.1136/gutjnl-2015-309260
[Indexed for MEDLINE]
Free PMC Article

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