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We read with interest the article by Lemoine et al evaluating routine tests as non-invasive markers of fibrosis in patients with chronic hepatitis B (CHB).1 The γ-glutamyl transpeptidase to platelet ratio (GPR) has been proposed as a new fibrosis test, allegedly more accurate than classical biomarkers like the Aspartate Aminotransferase to Platelet Ratio Index (APRI) and FIB-4 in African cohorts. Therefore, we performed a validation analysis of GPR in 147 patients with untreated CHB from two Brazilian reference centres. The mean age was 40.6±13.7 years and 68% were male. Hepatitis B e antigen (HBeAg) was positive in 53% of cases and median HBV-DNA level was 107 700 IU/mL. Median aspartate aminotransferase and alanine aminotransferase (ALT) levels (and IQR) were 42 (30–76) IU/L and 58 (42–106) IU/L, respectively. The distribution of fibrosis stages was as follows: METAVIR F0–22%, F1–27%, F2–22%, F3–16% and F4–13%.
Table 1 exhibits the diagnostic performances of GPR, APRI and FIB-4 for the detection of significant fibrosis …