Diagnostic performance of liver biochemical and hemostatic markers for assessing cirrhosis severity in chronic hepatitis B.

BACKGROUND

This study aimed to explore the utility of liver biochemical and hemostatic (including coagulation, anticoagulation, and fibrinolysis) markers for assessing cirrhosis severity in chronic hepatitis B (CHB) patients.

METHODS

In this current study, a total of 28 healthy controls and 78 patients with CHB-related cirrhosis were enrolled. Routine laboratory markers including platelet count (PLT), albumin (ALB), total bilirubin (TBIL), creatinine (CREA), prothrombin time (PT), activated partial thromboplastin time (APTT), factor VIII (FVIII), prothrombin activity (PA), protein S (PS), protein C (PC), antithrombin III (AT-III) and D-dimer (D-D) were measured. Correlations between the measured parameters and Child-Pugh score (CPS)/ Model for End-Stage Liver Disease score (MELD) were also explored. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the ability of these indicators to discriminate between mild and moderate-to-severe CHB-related cirrhosis.

RESULTS

Patients with CHB-related cirrhosis exhibited significantly lower levels of ALB, PA, PS, PC, AT-III, and PLT, and significantly higher levels of TBIL, PT, APTT, FVIII, and D-D, compared with healthy controls (p < 0.05). ALB, PA, AT-III, PS, and PC showed significant negative correlations with both CPS and MELD (p < 0.01). TBIL, PT, and APTT demonstrated significant positive correlations (p < 0.01). ROC curve analysis revealed that AT-III achieved an AUC of 0.95 (95% CI: 0.88-1.00) for distinguishing cirrhosis severity, followed by PC (AUC: 0.87) and PA (AUC: 0.87). As expected, Child-Pugh components (ALB, TBIL, PT) showed strong associations with the score.

CONCLUSION

Among markers not incorporated into the CPS, AT-III is significantly associated with the severity of CHB-related cirrhosis and exhibits promising discriminatory ability for staging CHB-related cirrhosis. It may support a low-cost, objective framework for dynamic monitoring of HBV-related cirrhosis progression. Although ALB, TBIL, and PT were also correlated with disease severity, these associations are subject to incorporation bias and thus represent confirmatory rather than novel findings.