PT  - JOURNAL ARTICLE
AU  - Maud Lemoine
AU  - Yusuke Shimakawa
AU  - Shevanthi Nayagam
AU  - Mustapha Khalil
AU  - Penda Suso
AU  - Jo Lloyd
AU  - Robert Goldin
AU  - Harr-Freeya Njai
AU  - Gibril Ndow
AU  - Makie Taal
AU  - Graham Cooke
AU  - Umberto D'Alessandro
AU  - Muriel Vray
AU  - Papa Saliou Mbaye
AU  - Ramou Njie
AU  - Vincent Mallet
AU  - Mark Thursz
TI  - The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa
AID  - 10.1136/gutjnl-2015-309260
DP  - 2016 Aug 01
TA  - Gut
PG  - 1369--1376
VI  - 65
IP  - 8
4099  - http://gut.bmj.com/content/65/8/1369.short
4100  - http://gut.bmj.com/content/65/8/1369.full
SO  - Gut2016 Aug 01; 65
AB  - Background Simple and inexpensive non-invasive fibrosis tests are highly needed but have been poorly studied in sub-Saharan Africa.Methods Using liver histology as a gold standard, we developed a novel index using routine laboratory tests to predict significant fibrosis in patients with chronic HBV infection in The Gambia, West Africa. We prospectively assessed the diagnostic accuracy of the novel index, Fibroscan, aspartate transaminase-to-platelet ratio index (APRI), and Fib-4 in Gambian patients with CHB (training set) and also in French and Senegalese CHB cohorts (validation sets).Results Of 135 consecutive treatment-naïve patients with CHB who had liver biopsy, 39% had significant fibrosis (Metavir fibrosis stage ≥F2) and 15% had cirrhosis (F4). In multivariable analysis, gamma-glutamyl transpeptidase (GGT) and platelet count were independent predictors of significant fibrosis. Consequently, GGT-to-platelet ratio (GPR) was developed. In The Gambia, the area under the receiver operating characteristic curve (AUROC) of the GPR was significantly higher than that of APRI and Fib-4 to predict ≥F2, ≥F3 and F4. In Senegal, the AUROC of GPR was significantly better than Fib-4 and APRI for ≥F2 (0.73, 95% CI 0.59 to 0.86) and better than Fib-4 and Fibroscan for ≥F3 (0.93, 0.87 to 0.99). In France, the AUROC of GPR to diagnose ≥F2 (0.72, 95% CI 0.59 to 0.85) and F4 (0.87, 0.76 to 0.98) was equivalent to that of APRI and Fib-4.Conclusions The GPR is a more accurate routine laboratory marker than APRI and Fib-4 to stage liver fibrosis in patients with CHB in West Africa. The GPR represents a simple and inexpensive alternative to liver biopsy and Fibroscan in sub-Saharan Africa.