The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa

Maud Lemoine (1, 2) , Yusuke Shimakawa (3, 1) , Shevanthi Nayagam (2) , Mustapha Khalil (4) , Penda Suso (4) , Jo Lloyd (2) , Robert Goldin (2) , Harr-Freeya Njai (1) , Gibril Ndow (1) , Makie Taal (5) , Graham Cooke (2) , Umberto d'Alessandro (1) , Muriel Vray (3) , Papa Saliou Mbaye (6) , Ramou Njie (1) , Vincent Mallet (7, 8, 9) , Mark Thursz (2)

1 MRC - Medical Research Council Unit The Gambia
2 Imperial College London
3 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
4 EFSTH - Edward Francis Small Teaching Hospital [Banjul, Gambia]
5 MOHSW - Ministry of Health and Social Welfare [Banjul, The Gambia]
6 Hôpital Principal de Dakar
7 Hôpital Cochin [AP-HP]
8 IP - Institut Pasteur [Paris]
9 UPD5 - Université Paris Descartes - Paris 5

Background: Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa. Methods: Using liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets). Results: Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4. Conclusions: The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.

Mots clés: HEPATITIS B; FIBROSIS

Domaines: Santé publique et épidémiologie

Maud Lemoine, Yusuke Shimakawa, Shevanthi Nayagam, Mustapha Khalil, Penda Suso, et al.. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut, 2016, 65 (8), pp.1369-1376. ⟨10.1136/gutjnl-2015-309260⟩. ⟨pasteur-02875304⟩