Establishment and validation of a non-invasive model of significant liver fibrosis in chronic HBV infected patients with MAFLD
Objective To explore the risk factors of significant liver fibrosis in chronic HBV infected patients with metabolic associated fatty liver disease(MAFLD),construct and validate a non-invasive model to predict significant liver fibrosis in liver tissue,and provide ideas for clinical initiation of anti fibrosis therapy.Methods A total of 445 chronic HBV infection with MAFLD who were admitted to the Department of Hepatology,Guangdong Provincial Hospital of Tradi-tional Chinese Medicine from Jan.2015 to Dec.2020 were retrospectively collected.They were divided into training cohort(n=274)and validation cohort(n=171)according to the time of admission.The training cohort was divided into no/slight liver fibrosis group(<S2 stage,n=106)and obvious fibrosis group(≥S2 stage,n=168)according to the pathologi-cal results.The clinical indicators of patients in the two groups were compared,and the risk factors of obvious liver fibrosis were screened according to the multifactor Logistic regression method.The prediction efficiency of the non-invasive model was evaluated by ROC curve.And it was verified in the validation cohort.Results Among 445 patients,287 patients(63.08%)had significant liver fibrosis,including 168 patients(61.31%)in the training cohort and 119 patients(69.59%)in the validation cohort.In the training cohort,the age,ALT,AST,ALP,GGT,PT,HBsAg,HBV DNA,LSM of patients in≥S2 group were higher than those in<S2 group,while WBC,RBC,PLT,TG,Urea were lower than those in<S2 group(P<0.05).Multivariate analysis showed that age,GGT,HBV DNA,LSM were independent risk fac-tors for significant liver fibrosis(P<0.05),and Urea was a protective factor(P<0.05).Establish non-invasive model ac-cording to age,GGT,Urea,HBV DNA and LSM:Y=0.063×age(year)+0.016×GGT(U/L)+0.246×HBV DNA(lg IU/L)+0.245×LSM(kPa)-0.484×Urea(mmol/L)-3.578,in the training cohort,the AUC for predicting significant liver fi-brosis was 0.827,which was higher than the predictive efficacy of APRI and FIB-4(P<0.05).The critical value Y= 0.70 of the point with the highest sensitivity and specificity was taken,at which time the predictive sensitivity was 62.5%and specificity was 92.5%.In the validation cohort,the prediction efficiency was 0.832,which was still higher than that of APRI and FIB-4(P<0.05).Conclusion Age,GGT,Urea,HBV DNA and LSM are the risk factors for significant liver fibrosis in chronic HBV infected patients with MAFLD.The non-invasive model established by this parameter has certain accuracy in predicting significant liver fibrosis in this population.
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