Role of Gamma Glutammyl Transpeptidase to Platelet Ratio (GPR) in Predicting Advanced Liver Fibrosis in Patients with Chronic Hepatitis C Infection
Journal of Advances in Medicine and Medical Research,
The liver biopsy is the gold standard for the diagnosis of liver fibrosis, because of its invasiveness, high cost and lack of repeatability its use is limited. A new parameter widely used these days for evaluating the grade of hepatic fibrosis is the gamma-glutamyl transpeptidase (GGT)-to-Platelet ratio (GPR) and has shown great benefit in this regard. The aim of our study was to evaluate the role of GPR as a noninvasive predictor of liver fibrosis in patients with chronic hepatitis C in the study population.
Methods: All patients with chronic hepatitis C and compensated liver disease were included in the study after informed consent. Patient’s baseline characteristics were recorded. Patient’s baseline Complete blood count (CBC) and Liver function tests were also recorded. Patients then underwent shear wave elastography (SWE) to stratify the degree of fibrosis. These indices were used to calculate Gamma glutamyl transpeptidase (GGT) / platelet ratio. Results were presented as means ± SD for quantitative data or as numbers with percentages for qualitative data. Continuous variables were analyzed using the Student’s t-test; while categorical variables were analyzed using the Chi-square test. A p value of <0.05 was considered statistically significant.
Results: A total of 91 patients were included in the study. Out of 91 patients, 56(61.5%) were males. At baseline, 57(62.6%) patients had ≥F3 fibrosis (advanced fibrosis or cirrhosis). Mean GPR was 1.5±2.1. Area under ROC (Receiver Operating Curve) was obtained for GPR in predicting advanced liver fibrosis (≥F3) was 0.8 (p-≤0.001). Higher GPR values were significantly associated with prediction of advanced liver fibrosis (≥F3) in patients with chronic hepatitis C with a sensitivity was of 94.74%, specificity of 62%, positive predictive value of 80.69%, negative predictive value was of 87.50% and diagnostic accuracy of 82.42%.
Conclusion: The GPR found to be significantly associated with liver fibrosis in HCV patients presented in our clinic. However, further studies are needed to validate the role of GPR in predicting liver fibrosis.
- shear wave elastography
- liver fibrosis
- gamma glutamyl transpeptidase
How to Cite
Hoofnagle JH, dI Bisceglie AM. The treatment of chronic viral hepatitis. N. Engl. J. Med. 1997;336:347-356.
Shiha G, et al. Asian-Pacific Association for the Study of the Liver (APASL) consensus guidelines on invasive and non-invasive assessment of hepatic fibrosis: a 2016 update. Hepatol. Int. 11, 1–30.
Cadranel JF, Rufat P. Degos F. Practice of liver biopsy in France: results of a prospective nationwide survey. For the Group of epidemiology of the French Association for the study of the liver (AEF). Hepatology. 2000;32:477–481.
Bravo AA, Sheth SG, Chopra S. Liver biopsy. N Engl J Med. 2001;344:495–500.
Piccinino F, Sagnelli E, Pasquale G, Giusti G.Complications following percutaneous liver biopsy. A multicenter retrospective study on 68,276 biopsies. J Hepatol. 1986; 2:165–173.
Zhang Z, Wang G, Kang K, Wu G, Wang P. The diagnostic accuracy and clinical utility of three noninvasive models for predicting liver fibrosis in patients with HBV infection. PLoS One. 2016;11: e0152757.
Kim JH, Kim MN, Han KH, Kim SU. Clinical application of transient elastography in patients with chronic viral hepatitis receiving antiviral treatment. Liver Int. 2015;35:1103–1115.
Seo YS, et al. Accuracy of transient elastography in assessing liver fibrosis in chronic viral hepatitis: A multicentre, retrospective study. Liver Int. 2015;35: 2246–2255
World Health Organization. Guidelines for the Prevention, Care and Treatment of Persons with Chronic Hepatitis B Infection; 2015.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003;38(20):518‐526.
Xiao G, Yang J, Yan L. Comparison of diagnostic accuracy of aspartate aminotransferase to platelet ratio index and fibrosis-4 index for detecting liver fibrosis in adult patients with chronic hepatitis B virus infection: a systemic review and meta-analysis. Hepatology. 2015;61:292‐302
Chen B, Ye B, Zhang J, Ying L, Chen Y. RDW to platelet ratio: a novel noninvasive index for predicting hepatic fibrosis and cirrhosis in chronic hepatitis B. PloS One. 8, e68780.
Lemoine M, et al. The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa. Gut. 2016;65: 1369–1376.
Li Q, et al. The Gamma-Glutamyl-Transpeptidase to Platelet Ratio Does not Show Advantages than APRI and Fib-4 in Diagnosing Significant Fibrosis and Cirrhosis in Patients with Chronic Hepatitis B: A Retrospective Cohort Study in China. Medicine. 2016;95:e3372.
Schiavon LL, Narciso-Schiavon JL, Ferraz MLG, Silva AEB, Carvalho-Filho RJ. The γ-glutamyl transpeptidase to platelet ratio (GPR) in HBV patients: just adding up? Gut; 2016.
Song P, et al. Performance of 2‐dimensional ultrasound shear wave elastography in liver fibrosis detection using magnetic resonance elastography as the reference standard: A Pilot study. J Ultrasoun; 2016.
Ding R, Lu W, Zhou X, Huang D,Wang Y, Li X, Yan L, Lin W, Song S,Zhang Z and Chen L. A Novel Non-invasive Model Based on GPR for the Prediction of Liver Fibrosis in Patients with Chronic Hepatitis B.Front. Med. 2021;8:727706.
Vardar R, Vardar E, Demiri S, Sayhan SE, Bayol U, Yildiz C, et al. Is there any noninvasive marker replace the needle liver biopsy predictive for liver fibrosis, in patients with chronic hepatitis? Hepatogastroenterology. 2009;56:1459–65.
Liu DP, Lu W, Zhang ZQ, Wang YB, Ding RR, Zhou XL, Huang D, Li XF. Comparative evaluation of GPR versus APRI and FIB‐4 in predicting different levels of liver fibrosis of chronic hepatitis B. Journal of Viral Hepatitis. 2018;25(5): 581-9.
Nada A, Sabry A, Elabd NS, Elbahr O. The Gamma-glutamyl Transpeptidase to Platelet Ratio (GPR) Predict Significant Liver Fibrosis and Cirrhosis in Chronic Egyptian HCV Patients. Afro-Egyptian Journal of Infectious and Endemic Diseases. 2020;10(2):226-32.
Abstract View: 31 times
PDF Download: 12 times