Correlation between Platelet-Albumin-Bilirubin (PALBI) Grades with Liver Stiffness in Chronic Hepatitis B Patients

Fitri Annisa Herdian, Dr. dr. Neneng Ratnasari, Sp.PD-KGEH; dr. Fahmi Indrarti, Sp.PD-KGEH; dr. Catharina Triwikatmani, Sp.PD-KGEH

2024 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang : Infeksi Hepatitis B termasuk penyebab infeksi hepatitis kronis terbanyak. Pada tahun 2019, WHO memperkirakan bahwa 296 juta orang menderita infeksi Hepatitis B kronis, dengan 18 juta kasus ditemukan di Asia Tenggara. Klasifikasi Child-Pugh (C-P) adalah metode yang sering digunakan dalam menilai fungsi hati pre-operatif. Namun, kemampuan diskriminasi dari penilaian ini terbatas. Pada 2015, metode Albumin-Bilirubin (ALBI) diperkenalkan oleh Johnson et al. Metode ini lebih sederhana, di mana pemeriksaan dilakukan dengan perhitungan parameter laboratorium yang memiliki kemampuan diskriminasi serta potensi prognosis yang lebih tinggi dibanding C-P. Di penelitian terbaru, jumlah platelet dimasukkan pada perhitungan ALBI, menciptakan metode Platelet-Albumin-Bilirubin (PALBI). Peradangan jangka panjang akan menyebabkan fibrosis, berkembang menjadi pre- sirosis dan sirosis, dan menyebabkan sumbatan pada aliran darah di hati, menyebabkan hipertensi portal. Untuk menghindari terjadinya hipertensi portal, penting untuk melakukan deteksi dini dan pengamatan progresi penyakit. Penelitian ini akan mengamati korelasi antara nilai PALBI dengan kekakuan hati pada pasien hepatitis kronis.

Tujuan : Untuk mengamati korelasi antara nilai PALBI dan kekakuan hati, serta kemampuan PALBI dalam deteksi dini kekakuan hati.

Metode : Penelitian ini menggunakan model studi potong lintang dengan pendekatan prospektif. Kekakuan hati akan diukur dengan elastografi dan divalidasi melalui tes KAPPA. Nilai PALBI dinilai dari tes laboratorium dan rumus tertentu. Analisis statistik akan dilakukan dengan IBM SPSS Statistics 25. Penelitian ini dilakukan hingga jumlah sampel terpenuhi dan setelah menerima persetujuan Komisi Komite Etik FK-KMK UGM.

Hasil : Analisis korelasi antara skor PALBI dan kekakuan hati berdasarkan elastografi transien menunjukkan korelasi yang tidak signifikan (r = -0.041). Berdasarkan subanalisis menggunakan T-test, ditemukan perbedaan signifikan (p = 0.030) pada skor PALBI dalam kelompok mild fibrosis (F0F1 – F2) and advanced fibrosis (F3 – F4).

Kesimpulan : Tidak terdapat korelasi antara skor PALBI dengan kekakuan hati pada pasien hepatisis B kronis. Skor PALBI dapat dijadikan metode deteksi dini untuk sirosis hati kompensata pada pasien hepatisis B kronis.

Background : Hepatitis B infections are of the most common causes of chronic hepatitis infection. In 2019, WHO estimated that 296 million people is suffering from chronic hepatitis B infection, with 18 million cases of chronic infection in the South-East Asia Region Child- Pugh (C-P) grade is a method that has been commonly used in assessing preoperative liver function. However, the discriminative function is limited. Albumin-Bilirubin (ALBI) method was first introduced in 2015 by Johnson et al. This method is simpler, which relies on laboratory parameters, with a more discriminative and higher prognostic potential compared to the C-P grade. Researchers had recently involved platelet count in the previously Albumin-Bilirubin method, creating the Platelet-Albumin-Bilirubin (PALBI) scoring method. As chronic infection happen, liver fibrosis will progress and it can lead to pre-cirrhosis and cirrhosis stage, resulting blockage of liver blood flow will occur, leading to portal hypertension. In order to prevent complications, early detection should be performed and carefully observed. This research will observe the correlation between PALBI grades with liver stiffness in chronic hepatitis B patients.

Aim of Study : To examine the correlation between PALBI grades with liver stiffness, and the potential of PALBI as early predictor of cirrhosis.?Methods : The study is a cross-sectional prospective study. Liver stiffness will be tested with FibroScan® with validation through the KAPPA test. PALBI score will be assessed through laboratory test and a certain formula. Statistical analysis will be performed with IBM SPSS Statistics 25. The study will take place until the sample size is met and after receiving approval from the Ethics Committee of the Faculty of Medicine, Public Health, and Nursing of UGM. Result : Correlation analysis of PALBI score and liver stiffness based on Transient Elastography results in no significant correlation (r = -0.041). Based on the subanalysis with T-test, there is a significant difference (p = 0.030) of PALBI score in mild fibrosis (F0F1 – F2) and advanced fibrosis (F3 – F4).

Conclusion : There is no correlation between PALBI score and liver stiffness in chronic hepatitis B patients. PALBI score is able to do early detection of compensated liver cirrhosis in chronic hepatitis B patients.

Kata Kunci : Chronic hepatitis, PALBI grade, liver stiffness, transient elastography