Clinical Characteristics of Indeterminate Chronic Hepatitis B Patients With and Without Liver Biopsy

ABSTRACT Background A substantial proportion of chronic hepatitis B (CHB) patients with indeterminate phase have significant liver injury, yet only a small proportion of these patients receive liver biopsy. We compared the clinical characteristics of indeterminate CHB patients with and without liver biopsy. Methods A total of 2928 untreated CHB patients with indeterminate phases were retrospectively included. The indeterminate phase was identified and classified based on the AASLD 2018 guidance. Results The median age of patients was 39.0 years and male accounted for 65.0%. A total of 288 (9.8%) CHB patients with the indeterminate phase underwent liver biopsy. Patients with liver biopsy were older (42.0 vs. 39.0 years, p < 0.001) and had higher HBV DNA (3.4 log 10 IU/mL vs. 2.7 log 10 IU/mL, p < 0.001), APRI (0.42 vs. 0.36, p < 0.001), FIB‐4 (1.18 vs. 0.99, p < 0.001), and liver stiffness values (9.9 vs. 6.6 kPa, p < 0.001), whereas lower platelets (169.0 × 10 9 /L vs. 192.0 × 10 9 /L, p < 0.001) than those without liver biopsy. Patients with PLT< 150.0 × 10 9 /L (OR 1.587, 95% CI 1.207–2.085, p < 0.001) and high HBV DNA (OR 1.458, 95% CI 1.298–1.637, p < 0.001) were more likely to receive liver biopsy in the indeterminate phase. Conclusion Only 9.8% of indeterminate CHB patients underwent liver biopsy in our cohort. These patients exhibited higher values on noninvasive fibrosis tests. Hepatic histologic findings from biopsied patients should be interpreted with caution and should not be generalized to all patients in the indeterminate phase.