The LAW index as an accurate indicator of the initiation of antiviral treatment in patients with chronic hepatitis B

Jae Min Lee, Yeon Seok Seo, Tae Hyung Kim, Jem Ma Ahn, Sun Young Yim, Seung Up Kim, Young Kul Jung, Ji Hoon Kim, Hyonggin An, Hyung Joon Yim, Jong Eun Yeon, Hong Sik Lee, Kwan Soo Byun, Soon-Ho Um, Chang Duck Kim, Ho Sang Ryu

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Abstract

Background and Aim: Considering that inflammation and fibrosis are major factors for the indication of antiviral treatment, liver stiffness measurements could help identify patients who require antiviral treatment. This study evaluated factors that best identify patients who require antiviral treatment and to develop a new indicator for chronic hepatitis B (CHB). Methods: Patients with CHB were randomly classified into a training or validation group, and a model for predicting necroinflammatory activity ≥ A3 or fibrosis grade ≥ F2 (A3F2) was established in the training group using binary regression analysis and validated in the validation group. Predictive efficacy was compared using area under the receiver-operating characteristics curve analysis. Results: Four-hundred ninety-two patients were enrolled. In the training group, female sex, aspartate aminotransferase-to-platelet count ratio index (APRI), and liver stiffness were independent predictors of A3F2 on multivariate analysis. These variables were used to construct a novel model, called the LAW (liver stiffness, APRI, woman) index, as follows: 1.5 × liver stiffness value (kPa) + 3.9 × APRI + 3.2 if female. The LAW index was a better predictor of A3F2 than the APRI or liver stiffness measurement in both training group (0.870; 95% confidence interval, 0.822–0.910) and validation group (0.862; 95% confidence interval, 0.813–0.903). Conclusions: The LAW index was able to accurately identify patients with CHB who required antiviral treatment. A LAW index of >10.1 could be a strong indicator for the initiation of antiviral treatment in patients with CHB.

Original languageEnglish
Pages (from-to)208-214
Number of pages7
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume32
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

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Chronic Hepatitis B
Antiviral Agents
Liver
Platelet Count
Transaminases
Therapeutics
Fibrosis
Confidence Intervals
Aspartate Aminotransferases
ROC Curve
Multivariate Analysis
Regression Analysis
Inflammation

Keywords

  • antiviral treatment
  • APRI
  • chronic hepatitis B
  • index
  • liver stiffness measurement

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

@article{01f4451f9b3843908e470449f963da66,
title = "The LAW index as an accurate indicator of the initiation of antiviral treatment in patients with chronic hepatitis B",
abstract = "Background and Aim: Considering that inflammation and fibrosis are major factors for the indication of antiviral treatment, liver stiffness measurements could help identify patients who require antiviral treatment. This study evaluated factors that best identify patients who require antiviral treatment and to develop a new indicator for chronic hepatitis B (CHB). Methods: Patients with CHB were randomly classified into a training or validation group, and a model for predicting necroinflammatory activity ≥ A3 or fibrosis grade ≥ F2 (A3F2) was established in the training group using binary regression analysis and validated in the validation group. Predictive efficacy was compared using area under the receiver-operating characteristics curve analysis. Results: Four-hundred ninety-two patients were enrolled. In the training group, female sex, aspartate aminotransferase-to-platelet count ratio index (APRI), and liver stiffness were independent predictors of A3F2 on multivariate analysis. These variables were used to construct a novel model, called the LAW (liver stiffness, APRI, woman) index, as follows: 1.5 × liver stiffness value (kPa) + 3.9 × APRI + 3.2 if female. The LAW index was a better predictor of A3F2 than the APRI or liver stiffness measurement in both training group (0.870; 95{\%} confidence interval, 0.822–0.910) and validation group (0.862; 95{\%} confidence interval, 0.813–0.903). Conclusions: The LAW index was able to accurately identify patients with CHB who required antiviral treatment. A LAW index of >10.1 could be a strong indicator for the initiation of antiviral treatment in patients with CHB.",
keywords = "antiviral treatment, APRI, chronic hepatitis B, index, liver stiffness measurement",
author = "Lee, {Jae Min} and Seo, {Yeon Seok} and Kim, {Tae Hyung} and Ahn, {Jem Ma} and Yim, {Sun Young} and Kim, {Seung Up} and Jung, {Young Kul} and Kim, {Ji Hoon} and Hyonggin An and Yim, {Hyung Joon} and Yeon, {Jong Eun} and Lee, {Hong Sik} and Byun, {Kwan Soo} and Soon-Ho Um and Kim, {Chang Duck} and Ryu, {Ho Sang}",
year = "2017",
month = "1",
day = "1",
doi = "10.1111/jgh.13447",
language = "English",
volume = "32",
pages = "208--214",
journal = "Journal of Gastroenterology and Hepatology (Australia)",
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TY - JOUR

T1 - The LAW index as an accurate indicator of the initiation of antiviral treatment in patients with chronic hepatitis B

AU - Lee, Jae Min

AU - Seo, Yeon Seok

AU - Kim, Tae Hyung

AU - Ahn, Jem Ma

AU - Yim, Sun Young

AU - Kim, Seung Up

AU - Jung, Young Kul

AU - Kim, Ji Hoon

AU - An, Hyonggin

AU - Yim, Hyung Joon

AU - Yeon, Jong Eun

AU - Lee, Hong Sik

AU - Byun, Kwan Soo

AU - Um, Soon-Ho

AU - Kim, Chang Duck

AU - Ryu, Ho Sang

PY - 2017/1/1

Y1 - 2017/1/1

N2 - Background and Aim: Considering that inflammation and fibrosis are major factors for the indication of antiviral treatment, liver stiffness measurements could help identify patients who require antiviral treatment. This study evaluated factors that best identify patients who require antiviral treatment and to develop a new indicator for chronic hepatitis B (CHB). Methods: Patients with CHB were randomly classified into a training or validation group, and a model for predicting necroinflammatory activity ≥ A3 or fibrosis grade ≥ F2 (A3F2) was established in the training group using binary regression analysis and validated in the validation group. Predictive efficacy was compared using area under the receiver-operating characteristics curve analysis. Results: Four-hundred ninety-two patients were enrolled. In the training group, female sex, aspartate aminotransferase-to-platelet count ratio index (APRI), and liver stiffness were independent predictors of A3F2 on multivariate analysis. These variables were used to construct a novel model, called the LAW (liver stiffness, APRI, woman) index, as follows: 1.5 × liver stiffness value (kPa) + 3.9 × APRI + 3.2 if female. The LAW index was a better predictor of A3F2 than the APRI or liver stiffness measurement in both training group (0.870; 95% confidence interval, 0.822–0.910) and validation group (0.862; 95% confidence interval, 0.813–0.903). Conclusions: The LAW index was able to accurately identify patients with CHB who required antiviral treatment. A LAW index of >10.1 could be a strong indicator for the initiation of antiviral treatment in patients with CHB.

AB - Background and Aim: Considering that inflammation and fibrosis are major factors for the indication of antiviral treatment, liver stiffness measurements could help identify patients who require antiviral treatment. This study evaluated factors that best identify patients who require antiviral treatment and to develop a new indicator for chronic hepatitis B (CHB). Methods: Patients with CHB were randomly classified into a training or validation group, and a model for predicting necroinflammatory activity ≥ A3 or fibrosis grade ≥ F2 (A3F2) was established in the training group using binary regression analysis and validated in the validation group. Predictive efficacy was compared using area under the receiver-operating characteristics curve analysis. Results: Four-hundred ninety-two patients were enrolled. In the training group, female sex, aspartate aminotransferase-to-platelet count ratio index (APRI), and liver stiffness were independent predictors of A3F2 on multivariate analysis. These variables were used to construct a novel model, called the LAW (liver stiffness, APRI, woman) index, as follows: 1.5 × liver stiffness value (kPa) + 3.9 × APRI + 3.2 if female. The LAW index was a better predictor of A3F2 than the APRI or liver stiffness measurement in both training group (0.870; 95% confidence interval, 0.822–0.910) and validation group (0.862; 95% confidence interval, 0.813–0.903). Conclusions: The LAW index was able to accurately identify patients with CHB who required antiviral treatment. A LAW index of >10.1 could be a strong indicator for the initiation of antiviral treatment in patients with CHB.

KW - antiviral treatment

KW - APRI

KW - chronic hepatitis B

KW - index

KW - liver stiffness measurement

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