Send to

Choose Destination
J Viral Hepat. 2017 Dec;24(12):1143-1150. doi: 10.1111/jvh.12751. Epub 2017 Aug 7.

The gamma-glutamyl transpeptidase-to-albumin ratio predicts significant fibrosis and cirrhosis in chronic hepatitis B patients.

Li Q1,2, Lu C1, Li W1, Huang Y1,2, Chen L1.

Author information

Department of Hepatitis, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, China.


Background/Aim Simple, inexpensive and clinically available noninvasive liver fibrosis tests are highly needed. We aimed to develop a novel noninvasive index for predicting significant fibrosis and cirrhosis in chronic hepatitis B (CHB) patients. Methods Using liver histology as gold standard, we developed a novel index to predict significant fibrosis and cirrhosis in CHB patients and then compared the diagnostic accuracy of the novel index, aspartate transaminase-to-platelet ratio index (APRI), and fibrosis index based on four factors (FIB-4) in a training set (606 patients) and a validation set (216 patients) from the same patient catchment area. Results Of 606 CHB patients in the training set, 33.2% had significant fibrosis and 11.4% had cirrhosis. In multivariable analysis, gamma-glutamyl transpeptidase (GGT) (OR=1.032, p<0.001) and albumin (OR=0.953, p=0.048) were independent predictors of significant fibrosis. Consequently, a GGT-to-albumin ratio (GAR) was developed. In the training set, the area under the receiver operating characteristic curve (AUROC) of GAR was significantly higher than that of APRI and FIB-4 to predict ≥F2 (0.82, 0.70, and 0.68, respectively), ≥F3 (0.86, 0.76, and 0.75, respectively), and F4 (0.88, 0.75, and 0.73, respectively), respectively. In the validation set, the AUROC of GAR was also better than APRI and FIB-4 for predicting ≥F2 (0.81, 0.63 and 0.61, respectively), ≥F3 (0.88, 0.78, and 0.76, respectively) and F4 (0.92, 0.85, and 0.78, respectively), respectively. Conclusions GAR is a more accurate noninvasive index than APRI and FIB-4 to stage significant fibrosis and cirrhosis in CHB patients and represents a novel noninvasive alternative to liver biopsy.


aspartate transaminase-to-platelet ratio index; chronic hepatitis B; cirrhosis; fibrosis index based on four factorsm; gamma-glutamyl transpeptidase-to-albumin ratio; significant fibrosis

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Wiley
Loading ...
Support Center