Comparative Biomarker Profiles Across Stages of Chronic Hepatitis B

Chronic hepatitis B (CHB), liver cirrhosis (LC), and hepatocellular carcinoma (HCC) are progressive stages of HBV infection that represent a global health concern. In many regions, advanced diagnostic tools are not readily available; therefore, accessible, cost-effective assays are needed to differentiate these disease stages. This study compared inflammatory, biochemical, and virological biomarker profiles, encompassing the neutrophil-to-lymphocyte ratio (NLR), platelet count, aspartate transaminase (AST), alanine transaminase (ALT), AST-to-platelet ratio index (APRI), fibrosis-4 score (FIB-4), and HBV DNA levels, across HBV-related liver disease stages. A retrospective cross-sectional study enrolled 213 patients with chronic HBV infection, categorized as CHB (n=166), LC (n=27), and HCC (n=20) at The General Hospital of West Nusa Tenggara Province between January 2022 and December 2023. The Kruskal-Wallis and post hoc tests were used for the analysis. The NLR was significantly higher in the HCC group compared to both the CHB (p=0.0001) and LC (p<0.01) groups. Platelet count revealed a progressive decline from CHB to LC (p<0.0001) but exhibited a subsequent increase from LC to HCC (p<0.0001), with no significant difference observed between the CHB and HCC groups. Aspartate transaminase (AST) levels increased significantly across all disease stages, whereas ALT levels showed no significant variation. Both APRI and FIB-4 scores were significantly higher in the LC and HCC groups compared to the CHB group (p<0.0001), but did not differ between LC and HCC. HBV DNA levels were elevated in HCC but failed to reach statistical significance. Consequently, these accessible biomarkers could play an important role in monitoring and staging HBV-induced liver disease in settings lacking advanced diagnostic facilities.