Gut Microbiota Dysbiosis, Immunological Response And The Performance Of Non-Invasive Models For Assessing Liver Fibrosis In Patients With Chronic Hepatitis B Virus

Abstract

Gut microbiota dysbiosis and lipopolysaccharide-mediated immune response has been linked with pathogenesis of complications and liver injuries in subjects with chronic hepatitis B virus infection. The levels of C-reactive protein (CRP), lipopolysaccharides (LPS), serum protein, platelet count (PLT), aspartate amino transferase (AST), and the performance of non-invasive models globulin to-platelet index (GPI), C-reactive protein to-albumin ratio (CAR), and aspartate to-platelet ratio index (APRI) in assessing fibrosis in patients with chronic hepatitis B virus infection (CHBV) were assessed in this case-control study.  The study enrolled 60 subjects with CHBV and 40 healthy controls. Platelet count was determined by a 5 parts Sysmex XS-1000 haematology automated analyzer, lipopolysaccharide was determined by sandwich-ELISA method, CRP was determined by latex Reagent agglutination method, AST, ALB, TP,  were determined by commercial colorimetric methods, C-reactive protein-albumin ratio (CAR), globulin-platelet index (GPI), aspartate-platelet ratio index (APRI),  were computed.  Data analysis was performed using analysis of variance, Pearson’s and DeLong’s test to compare the area under the receiver operating characteristic curve (AUROC) for the noninvasive markers, at α=0.05. Subjects with liver fibrosis (LF) had significantly higher LPS, CRP, AST, GLO, CAR, GPI and APRI and lower PLT, ALB, when compared with CHBV and control subjects. Log10 CAR correlated positively with Log10 GPI r= 0.464, P=0.000) respectively, CRP correlated positively with LPS and negatively with PLT (r=0.626, P=0.000 and r= -0.393, P=0.002) respectively, in the test subjects. The area under the curve for GPI, CAR and APRI were 0.923, 0.940, and 1.000 respectively. This study has shown that dysbiosis of the gut microbiota and LPS-mediated immune activation may underlie the pathogenesis of liver damage in subjects with chronic hepatitis B virus. The GPI, CAR and APRI models are good test instruments in predicting significant fibrosis and their use may represent simple and low-cost options in assessing liver injury in patients where FibroScan, transient elastography or liver biopsy is not accessible.