Association of Complete Blood Count-Derived Inflammatory Indices with Necroinflammatory Activity and Fibrosis Stages in Biopsy-Proven Chronic Hepatitis B: A Retrospective Cross-Sectional Study

Edilen Enflamatuvar İndekslerin Nekroenflamatuvar Aktivite ve Fibrozis Evresi ile İlişkisi: Retrospektif Kesitsel Bir ÇalışmaBackground: The aim of this study is to evaluate the association between inflammatory indices calculated from complete blood count (CBC) results and necroinflammatory activity and fibrosis stages determined by liver biopsy in patients with chronic hepatitis B (CHB). Materials and Methods:This retrospective study included 529 patients with biopsy-confirmed CHB.Fibrosis was staged with the Ishak system (F0-6); necroinflammatory activity was graded with the modified Histological Activity Index (mHAI, 0-18).Systemic immune-inflammation index (SII), systemic inflammation response index, aggregate index of systemic inflammation (AISI), neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio were calculated from the CBC results.For statistical analysis, patients were divided into two groups based on fibrosis stage: mild fibrosis (F0-2) and advanced fibrosis (F3-6), and based on necroinflammatory activity: low activity (mHAI <6) and high activity (mHAI ≥6).Statistical analyses included group comparisons, correlation and receiver operating characteristic analyses, and multivariate logistic regression.Results: Advanced fibrosis and high necroinflammatory activity were present in 29.5% and 23.8% of patients, respectively.SII, AISI, NLR, and PLR were significantly lower in advanced fibrosis (p < 0.050 for all) and showed weak negative correlations r = -0.090 to -0.183, p < 0.050 for all).In multivariate models, logPLR, logSII, and logAISI remained independently associated with advanced fibrosis (p < 0.001, p = 0.002, and p = 0.015, respectively).However, the area under the curve (95% confidence interval) was 0.623 (0.570-0.676) for PLR, 0.601 (0.548-0.655) for SII, and 0.559 (0.505-0.612) for AISI, indicating a low degree of discriminatory performance.None of the indices calculated for high necroinflammatory activity showed statistically significant differences between groups, nor were any independently associated.Conclusion: SII, AISI, and PLR are independently associated with advanced fibrosis in CHB.However, their low discriminatory power alone limits their clinical use.These indices should be considered complementary biological indicators rather than primary diagnostic tools for histological staging.