Diagnostic Performance of NLR, Type IV Collagen and Fibrosis Score in Chronic Hepatitis B

Abstract

Hepatitis B Virus (HBV) infection causes damage to the liver parenchyma and continuous injury resulting in liver fibrosis. The neutrophil/lymphocyte ratio is a non-invasive marker of inflammation. Type IV collagen is a direct marker of hepatic fibrosis, indicating the transformation of the extracellular matrix of the liver, and its concentration is proportional to the degree of damaged liver cells and impaired liver function. APRI score and FIB-4 index are non-invasive methods for determining the degree of liver fibrosis. This study aimed to assess the performance of the neutrophil/lymphocyte ratio, type IV collagen, and fibrosis score on liver fibrosis in chronic hepatitis B. The study design was analytical observational with a cross-sectional approach. The subjects included 42 chronic hepatitis B patients admitted to the Internal Medicine Department of Dr. Moewardi Hospital Surakarta from September to November 2020 and were grouped into fibrosis 21 (50%) and non-fibrosis 21 (50%) on transient elastography. Neutrophil-lymphocyte ratio, type IV collagen, and fibrosis score cut-off point were determined with Receiver Operating Curve (ROC), and a diagnostic test was performed with a 2x2 table. The cut-off point of 1.89 from the neutrophil/lymphocyte ratio obtained a sensitivity of 61.9% and specificity of 38.1%, with an AUC value of 0.524. In comparison, type IV collagen with a cut-off point of 18.32 ng/mL obtained a sensitivity of 80.9%, and specificity of 42.6% with an AUC of 0.642, a cut-off of 0.25 from the APRI score obtained a sensitivity of 81%, and specificity of 61.9% with an AUC of 0.857. Cut-off FIB-4 of 0.68 obtained a sensitivity of 85.7% and specificity of 71.4 with an AUC of 0.827. Neutrophil/lymphocyte ratio with a cut-off point of 1.89 has a weak diagnostic value on liver fibrosis in chronic hepatitis B. Further study by comparing or combining with other markers is needed. Type IV collagen with a cut-off of 18.32 ng/mL, APRI score with a cut-off of 0.25, and a FIB-4 index with a cut-off of 0.68 can be used for screening liver fibrosis in chronic hepatitis B patients.