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The LAW index as an accurate indicator of the initiation of antiviral treatment in patients with chronic hepatitis B

 Jae Min Lee  ;  Yeon Seok Seo  ;  Tae Hyung Kim  ;  Jem Ma Ahn  ;  Sun Young Yim  ;  Seung Up Kim  ;  Young Kul Jung  ;  Ji Hoon Kim  ;  Hyunggin An  ;  Hyung Joon Yim  ;  Jong Eun Yeon  ;  Hong Sik Lee  ;  Kwan Soo Byun  ;  Soon Ho Um  ;  Chang Duck Kim  ;  Ho Sang Ryu 
 Journal of Gastroenterology and Hepatology, Vol.32(1) : 208-214, 2017 
Journal Title
 Journal of Gastroenterology and Hepatology 
Issue Date
Adult ; Antiviral Agents/administration & dosage* ; Biomarkers* ; Drug Administration Schedule* ; Female ; Fibrosis ; Hepatitis B, Chronic/drug therapy* ; Hepatitis B, Chronic/pathology* ; Humans ; Liver/pathology* ; Male ; Middle Aged ; Multivariate Analysis ; Necrosis ; Predictive Value of Tests ; ROC Curve ; Regression Analysis ; Severity of Illness Index
APRI ; antiviral treatment ; chronic hepatitis B ; index ; liver stiffness measurement
BACKGROUND AND AIM: Considering that inflammation and fibrosis are major factors for the indication of antiviral treatment, liver stiffness measurements could help identify patients who require antiviral treatment. This study evaluated factors that best identify patients who require antiviral treatment and to develop a new indicator for chronic hepatitis B (CHB). METHODS: Patients with CHB were randomly classified into a training or validation group, and a model for predicting necroinflammatory activity ≥ A3 or fibrosis grade ≥ F2 (A3F2) was established in the training group using binary regression analysis and validated in the validation group. Predictive efficacy was compared using area under the receiver-operating characteristics curve analysis. RESULTS: Four-hundred ninety-two patients were enrolled. In the training group, female sex, aspartate aminotransferase-to-platelet count ratio index (APRI), and liver stiffness were independent predictors of A3F2 on multivariate analysis. These variables were used to construct a novel model, called the LAW (liver stiffness, APRI, woman) index, as follows: 1.5 × liver stiffness value (kPa) + 3.9 × APRI + 3.2 if female. The LAW index was a better predictor of A3F2 than the APRI or liver stiffness measurement in both training group (0.870; 95% confidence interval, 0.822-0.910) and validation group (0.862; 95% confidence interval, 0.813-0.903). CONCLUSIONS: The LAW index was able to accurately identify patients with CHB who required antiviral treatment. A LAW index of >10.1 could be a strong indicator for the initiation of antiviral treatment in patients with CHB.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Seung Up(김승업) ORCID logo https://orcid.org/0000-0002-9658-8050
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