Aspartate transaminase to platelet ratio index and gamma‐glutamyl transpeptidase‐to‐platelet ratio outweigh fibrosis index based on four factors and red cell distribution width‐platelet ratio in diagnosing liver fibrosis and inflammation in chronic hepatitis B

Background The benefits of using serum markers to diagnose stages of liver disease in chronic hepatitis B ( CHB ) patients are controversial. We conducted a study to compare the clinical significance of four markers in evaluating liver inflammation and fibrosis in CHB patients. Methods A total of 323 treatment‐naive CHB patients who received a liver biopsy and routine laboratory testing were enrolled in our study. We used the Scheuer scoring system as a pathological standard for diagnosing liver inflammation and fibrosis. The diagnostic performance of the fibrosis index based on four factors ( FIB ‐4), the aspartate transaminase to platelet ratio index ( APRI ), the gamma‐glutamyl transpeptidase‐to‐platelet ratio ( GPR ), and the red cell distribution width‐platelet ratio ( RPR ) were analyzed with receiver‐operating characteristic curves ( ROC ). Results No significant differences among the four indexes for diagnosing significant fibrosis (S ≥ 2) was found, while APRI and GPR were superior to FIB ‐4 and RPR in diagnosing moderate (G ≥ 2), severe (G ≥ 3) inflammation, and severe fibrosis (S ≥ 3). The AUROC s for diagnosing G ≥ 2 and G ≥ 3 were 0.732 and 0.861 for APRI , 0.726 and0.883 for GPR , 0.703 and0.705 for FIB ‐4, and 0.660 and 0.747 for RPR , respectively. The AUROC s for diagnosing S ≥ 2 and S ≥ 3 were0.724 and 0.799 for APRI , 0.714 and0.801 for GPR , 0.683 and0.730 for FIB ‐4, and 0.643 and 0.705 for RPR , respectively. Conclusion APRI and GPR were more effective than FIB ‐4 and RPR at diagnosing liver inflammation and fibrosis.