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      Evaluation of a logistic regression model for predicting liver necroinflammation in hepatitis B e antigen-negative chronic hepatitis B patients with normal and minimally increased alanine aminotransferase levels.

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          Abstract

          Liver necroinflammation is the indicator for treating patients with chronic hepatitis B (CHB) infection. However, there is no suitable non-invasive index for diagnosing liver necroinflammation. This study aimed to create a non-invasive index to predict liver necroinflammation in patients who lack clear-cut clinical inflammation parameters. Patients who were hepatitis B e antigen (HBeAg)-negative and underwent liver histological diagnosis, had a normal or minimally increased alanine aminotransferase (ALT) level were enrolled. Liver necroinflammation was defined as histological active index ≥4. A logistic regression model (LRM) was established based on the parameters independently associated with liver necroinflammation. Of all 550 patients, 36.73% had necroinflammation. In patients with an abnormal ALT level, the rate of necroinflammation was 52.49%. The area under the curve (AUC) of the ALT level for predicting necroinflammation was 0.655 (95% confidence interval [CI], 0.609-0.702), and that of the HBV DNA level ≥2000 IU/mL combined with an abnormal ALT level was 0.618. By using the LRM, the AUC improved to 0.769 (95% CI, 0.723-0.815) with a Youden index of 0.519 and diagnostic accuracy of 75.3%. The cutoff value ≥0.7 in the LRM had a specificity of 97.4% and positive predictive value of 85.0% for predicting necroinflammation. By using the cutoff value <0.15 in the LRM, the presence of necroinflammation could be excluded with a negative predictive value of 90.8%. This study indicated that the LRM can be used to effectively diagnose liver necroinflammation in HBeAg-negative patients with CHB who have normal or minimally elevated ALT levels.

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          Author and article information

          Journal
          Journal of viral hepatitis
          Wiley
          1365-2893
          1352-0504
          July 2019
          : 26 Suppl 1
          Affiliations
          [1 ] Department of Hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
          [2 ] Department of Gynecology and Obstetrics, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
          [3 ] Department of Pathology, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
          [4 ] Medical Records and Statistics Department, Beijing Ditan Hospital, Capital Medical University, Beijing, China.
          Article
          10.1111/jvh.13163
          31380591
          44e24331-f048-4e4d-952f-a8ba971c4bb2
          History

          HBeAg negative,ALT level,logistic regression model,chronic hepatitis B,liver inflammation

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