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Background <p>In patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD), non-invasive diagnosis of advanced fibrosis remains challenging, while these stages are critical for prognosis and therapeutic decision-making. Existing non-invasive models cannot simultaneously ensure effective rule-out and rule-in, whereas the dual cutoff strategy provides a feasible clinical approach. This study aimed to evaluate the diagnostic performance of Liver stiffness measurement-to-platelet ratio index (LPRI) for advanced fibrosis in this population and to explore its clinical utility in risk stratification.</p> Methods <p>A retrospective analysis was performed on 673 CHB patients with NAFLD confirmed by liver biopsy from 2018 to 2025. Receiver operating characteristic (ROC) curves were constructed to analyze and compare the diagnostic performance of LPRI, liver stiffness measurement (LSM), the fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and Hui score in diagnosing stage S3 fibrosis, advanced fibrosis, and cirrhosis. A dual cutoff strategy was applied, using 90% sensitivity and specificity to determine rule-out and rule-in thresholds, stratifying patients into low-risk, indeterminate, and high-risk groups for clinical risk management.</p> Results <p>LPRI values were markedly higher in patients with stage S3 fibrosis and cirrhosis compared with those in the S1–S2 stages. LPRI demonstrated good diagnostic performance for advanced fibrosis and stage S3 fibrosis, with AUROCs of 0.904 and 0.854, respectively. For cirrhosis, LPRI achieved an AUROC of 0.919, outperforming LSM, APRI, and Hui score (<i>P</i> &lt; 0.05). For advanced fibrosis, the rule-out threshold was 5.39 (Se = 90.0%, Sp = 79.3%), with 75.0% of patients classified as low risk. The rule-in threshold was 6.93 (Sp = 90.0%, Se = 63.8%), with 14.9% in the high-risk zone and 10.1% in the indeterminate zone (5.39–6.93). For cirrhosis, the rule-out threshold was 6.44 (Se = 90.0%, Sp = 74.1%), with 82.0% classified as low risk. The rule-in threshold was 6.74 (Sp = 90.0%, Se = 77.4%), defining 16.6% as high risk and 1.4% as indeterminate (6.44–6.74).</p> Conclusion <p>LPRI shows good value in predicting and excluding advanced fibrosis and cirrhosis in patients with CHB combined with NAFLD, and can reduce diagnostic uncertainty for advanced fibrosis, thereby decreasing unnecessary liver biopsies and improving screening efficiency.</p>

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Diagnostic value of LPRI for assessing advanced liver fibrosis in patients with chronic hepatitis B and non-alcoholic fatty liver disease

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年2月4日

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  • Min Wang,
  • Huaxiao Chen,
  • Jiaen Yang,
  • Xueting Huang,
  • Runyan He,
  • Baohui Pei,
  • Xiaolu Wu,
  • Yanneng Kang,
  • Longhao Xu

摘要

Background

In patients with chronic hepatitis B (CHB) and non-alcoholic fatty liver disease (NAFLD), non-invasive diagnosis of advanced fibrosis remains challenging, while these stages are critical for prognosis and therapeutic decision-making. Existing non-invasive models cannot simultaneously ensure effective rule-out and rule-in, whereas the dual cutoff strategy provides a feasible clinical approach. This study aimed to evaluate the diagnostic performance of Liver stiffness measurement-to-platelet ratio index (LPRI) for advanced fibrosis in this population and to explore its clinical utility in risk stratification.

Methods

A retrospective analysis was performed on 673 CHB patients with NAFLD confirmed by liver biopsy from 2018 to 2025. Receiver operating characteristic (ROC) curves were constructed to analyze and compare the diagnostic performance of LPRI, liver stiffness measurement (LSM), the fibrosis-4 index (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and Hui score in diagnosing stage S3 fibrosis, advanced fibrosis, and cirrhosis. A dual cutoff strategy was applied, using 90% sensitivity and specificity to determine rule-out and rule-in thresholds, stratifying patients into low-risk, indeterminate, and high-risk groups for clinical risk management.

Results

LPRI values were markedly higher in patients with stage S3 fibrosis and cirrhosis compared with those in the S1–S2 stages. LPRI demonstrated good diagnostic performance for advanced fibrosis and stage S3 fibrosis, with AUROCs of 0.904 and 0.854, respectively. For cirrhosis, LPRI achieved an AUROC of 0.919, outperforming LSM, APRI, and Hui score (P < 0.05). For advanced fibrosis, the rule-out threshold was 5.39 (Se = 90.0%, Sp = 79.3%), with 75.0% of patients classified as low risk. The rule-in threshold was 6.93 (Sp = 90.0%, Se = 63.8%), with 14.9% in the high-risk zone and 10.1% in the indeterminate zone (5.39–6.93). For cirrhosis, the rule-out threshold was 6.44 (Se = 90.0%, Sp = 74.1%), with 82.0% classified as low risk. The rule-in threshold was 6.74 (Sp = 90.0%, Se = 77.4%), defining 16.6% as high risk and 1.4% as indeterminate (6.44–6.74).

Conclusion

LPRI shows good value in predicting and excluding advanced fibrosis and cirrhosis in patients with CHB combined with NAFLD, and can reduce diagnostic uncertainty for advanced fibrosis, thereby decreasing unnecessary liver biopsies and improving screening efficiency.