ArticleBMC gastroenterology2026
Diagnostic value of LPRI for assessing advanced liver fibrosis in patients with chronic hepatitis B and non-alcoholic fatty liver disease.
Article in BMC gastroenterology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn 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.
methodsA 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.
resultsLPRI 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).
conclusionLPRI 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.
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