The performances of routine tests such as FIB-4 and APRI in detecting cirrhosis and significant fibrosis in chronic hepatitis B (CHB) have been shown to be discrepant between studies.Novel testssuch asred cell distribution width-platelet ratio (RPR), γ-glutamyl transpeptidase to platelet ratio (GPR) andeasy liver fibrosis test (eLIFT) have also been introduced recently. To evaluate the aminotransferase influence on the performance of theseroutine tests, a total of 1005 CHB patients who underwent liver biopsies and routine tests were retrospectively analyzed.The diagnostic cutoffs referring to likelihood ratio were determined for excluding or including cirrhosis diagnosis, and also for ruling in significant fibrosis diagnosis.Theperformances ofRPR, FIB-4, eLIFT and APRI in detecting cirrhosis seemedimproved athigher ALTlevels, whistGPR was conversely impaired. The likelihood ratios of APRI 2 indiagnosing cirrhosisatALT< 2 upper limit of normal (ULN), APRI 1.5 in determiningsignificant fibrosisatALT ≤5ULN andFIB-4 3.2 in diagnosing ≥Metavir F3 in the total cohort was∝, 14.6 and 20.6, respectively. The optimal cutoffs for cirrhosis diagnosis were increased with higher ALTs by testswhich included aminotransferaselevel, but not for RPR. The proportions of patients classifiedas having cirrhosis or nocirrhosis stratified by ALT level cutoffs were superior.Stepwise applying RPR, GPR and eLIFT would determine 60% of patients as having cirrhosis or nocirrhosis with an accuracy of 93.0%. In conclusion, the performance of aminotransferase comprisingtestsin detectingcirrhosis in CHB were influenced by ALT levels.Thus ALT stratified cutoffs may be a preferred alternative. In resource-limited settings, stepwise applying routine tests could be recommended as a preferred measurement for cirrhosis detection.
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