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The γ-glutamyl transpeptidase to platelet ratio (GPR) in HBV patients: just adding up?
  1. Leonardo L Schiavon1,
  2. Janaína L Narciso-Schiavon1,
  3. Maria Lucia G Ferraz2,
  4. Antonio E B Silva2,
  5. Roberto J Carvalho-Filho2
  1. 1Division of Gastroenterology, Department of Internal Medicine, Federal University of Santa Catarina, Florianopolis, Brazil
  2. 2Division of Gastroenterology, Hepatitis Section, Federal University of Sao Paulo, Sao Paulo, Brazil
  1. Correspondence to Professor Leonardo de Lucca Schiavon, Rua Deputado Antonio Edu Vieira, 1310, Casa 217,Florianópolis, SC 88.040-001, Brazil; leo-jf{at}

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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 …

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  • Contributors All authors have contributed significantly to the work.

  • Competing interests None declared.

  • Ethics approval Comitê de Ética em Pesquisa com Seres Humanos da Universidade Federal de Santa Catarina.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data sharing statement Technical appendix, statistical code and data set available from the corresponding author at