Letter to the Editor 3.25 (high cutoff values) to distinguish F0–F2 and F3–F4 Simple noninvasive tests for the detection of for FIB-4 . However, the above thresholds of APRI and advanced liver ﬁbrosis in patients with chronic FIB-4 are recommended for diagnosing signiﬁcant ﬁbrosis hepatitis B (≥ F2) rather than advanced ﬁbrosis (F3–F4) in the WHO guidelines for CHB . Thus, the results might be biased if a c d b a Rui Huang , Xiang-An Zhao , Jian Wang , Yingying Hao and Chao Wu , a b the authors used these thresholds for diagnosing advanced Departments of Infectious Diseases, Intensive Care Unit, Nanjing Drum Tower ﬁbrosis (F3–F4). Hospital, Nanjing University Medical School, Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Traditional Chinese and Western Therefore, large-scale studies with well-deﬁned inclusion Medicine, Nanjing University of Chinese Medicine and Department of Infectious and exclusion criteria are required to validate the diagnostic Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical accuracy of NITs and establish optimal thresholds for the University, Nanjing, Jiangsu Province, China detection of different ﬁbrosis stages in CHB patients. Correspondence to Chao Wu, MD, PhD, Department of Infectious Diseases, Nanjing Drum Tower Hospital, Nanjing University Medical School, 321 Zhongshan Acknowledgements Road, Nanjing 210008, Jiangsu Province, China Tel: + 86 258 310 5890; fax: + 86 258 330 7115; e-mail: email@example.com The study was supported from the National Natural Science Foundation of China (81672025 and 81702011), Medical Science and Technology Development Foundation of Received 11 October 2017 Accepted 12 October 2017 Nanjing (ZDX16004 and YKK16118), Jiangsu Provincial Medical Innovation Team (CXTDA2017005), Natural We read with great interest the article by Lang et al.  in Science Foundation of Jiangsu Province for Young Scholar which they analyzed the diagnostic performance of simple (BK20160121), and Nanjing Medical Science and Technique noninvasive tests (NITs) including the ﬁbrosis index based on Development Foundation (QRX17121). the four factors (FIB-4), aspartate aminotransferase–alanine aminotransferase ratio index, aspartate aminotransferase- Conﬂicts of interest to-platelet ratio index (APRI), and age–platelet index for There are no conﬂicts of interest. the detection of advanced ﬁbrosis (F3–F4) in 239 chronic hepatitis B (CHB) patients. They could not conﬁrm a reliable clinical utility for these NITs for prediction of advanced References ﬁbrosis in CHB patients with a predominantly Caucasian 1 Lang S, Kütting F, Staub A, Schramowski J, Schramm C, Kasper P, et al. population . The study is very interesting. However, the Performance of simple noninvasive scoring systems for the prediction of advanced ﬁbrosis in patients with chronic hepatitis B. Eur J Gastroenterol results should be interpreted with cautions. Hepatol 2017; 29:1235–1240. First, platelet count is an important component in most 2 Zencir C, Akpek M, Senol S, Selvi M, Onay S, Cetin M, et al. Association of the NITs in the study . The platelets are easily affected between hematologic parameters and in-hospital mortality in patients by many factors such as infections, chronic inﬂammatory with infective endocarditis. Kaohsiung J Med Sci 2015; 31:632–638. 3 Shiha G, Ibrahim A, Helmy A, Sarin SK, Omata M, Kumar A, et al. Asian- diseases, some hematological disorders, and drug use [2–4]. Paciﬁc Association for the Study of the Liver (APASL) consensus However, the authors only excluded the patients with guidelines on invasive and non-invasive assessment of hepatic ﬁbrosis: a coexisting viral infection and alcohol abuse . The patients 2016 update. Hepatol Int 2017; 11:1–30. were not evaluated for the existence of comorbidities such as 4 Tseng PL, Wang JH, Hung CH, Tung HD, Chen TM, Huang WS, et al. chronic inﬂammatory diseases and hematological disorders, Comparisons of noninvasive indices based on daily practice parameters for predicting liver cirrhosis in chronic hepatitis B and hepatitis C patients which might have affected the results. in hospital and community populations. Kaohsiung J Med Sci 2013; Second, in the study by Lang et al. , CHB patients 29:385–395. were divided into two groups according to the stage of 5WHO. Guidelines for the prevention, care and treatment of persons with ﬁbrosis by liver biopsy: mild ﬁbrosis (F0–F2) and chronic hepatitis B infection. Geneva, Switzerland: World Health Organization; advanced ﬁbrosis (F3–F4). The authors used 0.5 (low cutoff values) and 1.5 (high cutoff values) to distinguish DOI: 10.1097/MEG.0000000000001020 F0–F2 and F3–F4 for APRI, 1.45 (low cutoff values) and European Journal of Gastroenterology & Hepatology 2018, 30:241 0954-691X Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved. 241 Copyright r 2018 Wolters Kluwer Health, Inc. All rights reserved.
European Journal of Gastroenterology & Hepatology – Wolters Kluwer Health
Published: Feb 1, 2018
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