Prediction of long-term clinical outcome in a diverse chronic hepatitis b population: role of the PAGE-B score

Background & Aims An abundance of non-invasive scores have been associated with fibrosis and hepatocellular carcinoma (HCC) development. We aimed to compare the prognostic ability of these scores in relation to liver histology in chronic hepatitis B (CHB) patients. Methods Liver biopsies from treatment-naive CHB patients at one tertiary care centre were scored by a single hepato-pathologist. Laboratory values at liver biopsy were used to calculate the PAGE-B, REACH-B, GAG-HCC, CU-HCC, and FIB-4 scores. Any clinical event was defined as HCC development, liver failure, transplantation and mortality. HCC and mortality data was obtained from national database registries. Results Of 557 patients, 40 developed a clinical event within a median follow-up of 10.1 (IQR 5.7-15.9) years. The PAGE-B score predicted any clinical event (C-statistic 0.86, 95%CI: 0.80-0.92), HCC development (C-statistic 0.91) and reduced transplant-free survival (C-statistic 0.83) with good accuracy, also when stratified by ethnicity, antiviral therapy after biopsy or advanced fibrosis. The C-statistics (95%CI) of the REACH-B, GAG-HCC, CU-HCC, and FIB-4 scores for any event were 0.70 (0.59-0.81), 0.82 (0.75-0.89), 0.73 (0.63-0.84), and 0.79 (0.69-0.89), respectively. The PAGE-B event risk assessment improved modestly when combined with the Ishak fibrosis stage (C-statistic 0.87, 95%CI: 0.82-0.93). Conclusions The PAGE-B score showed the best performance in assessing the likelihood of developing a clinical event among a diverse CHB population over 15 years of follow-up. Additional liver histologic characteristics did not appear to provide a clinically significant improvement. This article is protected by copyright. All rights reserved.