The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection
We aim to investigate the impact of different clinical phases’ definitions of chronic hepatitis B (CHB) infection on the profiles of grey zone, based on HBV guidelines set by the Chinese Society of Hepatology and Chinese Society of Infectious Diseases (CSH/CSID, 2022 version) and guidelines set by t...
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MDPI AG
2023-05-01
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| Series: | Viruses |
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| Online Access: | https://www.mdpi.com/1999-4915/15/5/1212 |
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| author | Xiaoqian Xu Hao Wang Shan Shan Yameng Sun Xiaoyuan Xu Hong You Jidong Jia Hui Zhuang Yuanyuan Kong on behalf of the China Registry of Hepatitis B (CR-HepB) Group |
| author_facet | Xiaoqian Xu Hao Wang Shan Shan Yameng Sun Xiaoyuan Xu Hong You Jidong Jia Hui Zhuang Yuanyuan Kong on behalf of the China Registry of Hepatitis B (CR-HepB) Group |
| author_sort | Xiaoqian Xu |
| collection | DOAJ |
| description | We aim to investigate the impact of different clinical phases’ definitions of chronic hepatitis B (CHB) infection on the profiles of grey zone, based on HBV guidelines set by the Chinese Society of Hepatology and Chinese Society of Infectious Diseases (CSH/CSID, 2022 version) and guidelines set by the American Association for the Study of Liver Diseases (AASLD, 2018 version). We retrospectively examined untreated CHB patients enrolled in the China Registry of Hepatitis B database. Patients’ clinical phases were determined as per CSH/CSID and AASLD. Liver fibrosis was estimated by FIB-4 and/or APRI. Among 3462 CHB patients, 56.9% and 41.7% fell into the grey zone based on AASLD and CSH/CSID. Compared with grey zone patients as per AASLD, those under CSH/CSID guidelines showed lower levels of median ALT (26.0 vs. 37.0 U/L, <i>p</i> < 0.001), AST (25.0 vs. 29.4 U/L, <i>p <</i> 0.001) and APRI (0.3 vs. 0.4, <i>p</i> < 0.001), and lower rates of advanced fibrosis estimated by APRI (7.9% vs. 11.4% <i>p =</i> 0.001), but comparable rates by FIB-4 (13.0% vs. 14.1%, <i>p</i> = 0.389). With the stepwise lowering of ALT upper limits of normal (ULN) values from 50/40 U/L for males/females to 40/40 U/L, 35/25 U/L and 30/19 U/L, the proportions of grey zone patients as per CSH/CSID declined from 46.7% to 41.7%, 34.3% and 28.8%, respectively, whereas they remained stable (55.7%, 56.2%, 56.9% and 57.0%) as per AASLD. Compared with the AASLD guidelines, CSH/CSID guidelines leave fewer and less severe patients in the grey zone. Lowering ALT ULN values reduces the number of grey zone patients as per CSH/CSID, but not under AASLD guidelines. |
| first_indexed | 2024-03-11T03:14:54Z |
| format | Article |
| id | doaj.art-e898a18c02af4d40a4dcfbb1e5776404 |
| institution | Directory Open Access Journal |
| issn | 1999-4915 |
| language | English |
| last_indexed | 2024-03-11T03:14:54Z |
| publishDate | 2023-05-01 |
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| spelling | doaj.art-e898a18c02af4d40a4dcfbb1e57764042023-11-18T03:40:34ZengMDPI AGViruses1999-49152023-05-01155121210.3390/v15051212The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus InfectionXiaoqian Xu0Hao Wang1Shan Shan2Yameng Sun3Xiaoyuan Xu4Hong You5Jidong Jia6Hui Zhuang7Yuanyuan Kong8on behalf of the China Registry of Hepatitis B (CR-HepB) GroupClinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing 100050, ChinaClinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing 100050, ChinaLiver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, ChinaLiver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, ChinaDepartment of Infectious Diseases, Peking University First Hospital, Beijing 100034, ChinaLiver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, ChinaLiver Research Center, Beijing Friendship Hospital, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing 100050, ChinaDepartment of Microbiology and Infectious Disease Center, Peking University Health Science Center, Beijing 100191, ChinaClinical Epidemiology and EBM Unit, Beijing Friendship Hospital, Capital Medical University, Beijing Clinical Research Institute, Beijing 100050, ChinaWe aim to investigate the impact of different clinical phases’ definitions of chronic hepatitis B (CHB) infection on the profiles of grey zone, based on HBV guidelines set by the Chinese Society of Hepatology and Chinese Society of Infectious Diseases (CSH/CSID, 2022 version) and guidelines set by the American Association for the Study of Liver Diseases (AASLD, 2018 version). We retrospectively examined untreated CHB patients enrolled in the China Registry of Hepatitis B database. Patients’ clinical phases were determined as per CSH/CSID and AASLD. Liver fibrosis was estimated by FIB-4 and/or APRI. Among 3462 CHB patients, 56.9% and 41.7% fell into the grey zone based on AASLD and CSH/CSID. Compared with grey zone patients as per AASLD, those under CSH/CSID guidelines showed lower levels of median ALT (26.0 vs. 37.0 U/L, <i>p</i> < 0.001), AST (25.0 vs. 29.4 U/L, <i>p <</i> 0.001) and APRI (0.3 vs. 0.4, <i>p</i> < 0.001), and lower rates of advanced fibrosis estimated by APRI (7.9% vs. 11.4% <i>p =</i> 0.001), but comparable rates by FIB-4 (13.0% vs. 14.1%, <i>p</i> = 0.389). With the stepwise lowering of ALT upper limits of normal (ULN) values from 50/40 U/L for males/females to 40/40 U/L, 35/25 U/L and 30/19 U/L, the proportions of grey zone patients as per CSH/CSID declined from 46.7% to 41.7%, 34.3% and 28.8%, respectively, whereas they remained stable (55.7%, 56.2%, 56.9% and 57.0%) as per AASLD. Compared with the AASLD guidelines, CSH/CSID guidelines leave fewer and less severe patients in the grey zone. Lowering ALT ULN values reduces the number of grey zone patients as per CSH/CSID, but not under AASLD guidelines.https://www.mdpi.com/1999-4915/15/5/1212chronic hepatitis Bantiviral therapygrey zoneindeterminate phase |
| spellingShingle | Xiaoqian Xu Hao Wang Shan Shan Yameng Sun Xiaoyuan Xu Hong You Jidong Jia Hui Zhuang Yuanyuan Kong on behalf of the China Registry of Hepatitis B (CR-HepB) Group The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection Viruses chronic hepatitis B antiviral therapy grey zone indeterminate phase |
| title | The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection |
| title_full | The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection |
| title_fullStr | The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection |
| title_full_unstemmed | The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection |
| title_short | The Impact of the Definitions of Clinical Phases on the Profiles of Grey-Zone Patients with Chronic Hepatitis B Virus Infection |
| title_sort | impact of the definitions of clinical phases on the profiles of grey zone patients with chronic hepatitis b virus infection |
| topic | chronic hepatitis B antiviral therapy grey zone indeterminate phase |
| url | https://www.mdpi.com/1999-4915/15/5/1212 |
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