Prevalence and Predicting Factors of Significant Liver Fibrosis Evaluated by Transient Elastography in Patients with Chronic Hepatitis B Aged 40 Years or More
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Abstract
BACKGROUND: Chronic hepatitis B ensues chronic liver inflammation resulting in liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. Detection of the early stages of liver fibrosis by non-invasive methods; such as, transient elastography is the key recommendation under the current guidelines, especially in patients aged 40 years or more. However, the prevalence and predicting factors of significant liver fibrosis in Thai patients aged 40 years or more have not yet been studied.
OBJECTIVES: To study the prevalence and predicting factors of significant liver fibrosis evaluated by transient elastography in patients with chronic hepatitis B aged 40 years or more.
METHODS: This cross-sectional study consisted of 150 patients with chronic hepatitis B aged 40 years or more who were evaluated with liver fibrosis by transient elastography at the Special Investigation Unit, Department of Internal Medicine, Phrapokklao Hospital, Chanthaburi Province, Thailand during January 2017-August 2020. The demographic data, laboratory data, hepatitis B profile data, as well as results from transient elastography were collected for analysis. Significant liver fibrosis was determined as ≥7 Kilopascal.
RESULTS: The results showed that 47.3% of patients with chronic hepatitis B aged 40 years or more who had been evaluated by transient elastography had the prevalence of significant liver fibrosis. Significant liver fibrosis had a statistically significant association with sex, positive HBeAg, negative anti-HBe, serum HBV-DNA≥20,000 IU/mL, and the active disease group. In comparison to non-significant liver fibrosis, the group with significant liver fibrosis had a statistically significant lower mean of the platelet and albumin level and a higher mean of INR, Globulin, Bilirubin, AST, ALT, and ALP, as well as higher median of serum HBV-DNA. Additionally, the multivariate logistic regression analysis showed the platelets <150,000/mm3 (OR 7.35; 95%CI 1.64-33.0; p=0.01) and INR>1.1 (OR 5.77; 95%CI 1.53-21.78; p=0.01) were predicting factors for significant liver fibrosis.
CONCLUSION: The prevalence of significant liver fibrosis evaluated by transient elastography in patients with chronic hepatitis B aged 40 years or more was nearly half of the total number of patients. The predicting factors for significant liver fibrosis were platelets <150,000/mm3 and INR>1.1. Patients with these predictors should be evaluated for liver fibrosis by transient elastography for an optimal follow-up or initiation of treatment.
Thaiclinicaltrials.org number, TCTR 20220126005
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