Neutrophil extracellular trapping networks (NETs) are meshwork structures released by activated neutrophils and are composed of various components such as DNA, histones and granulins. The aim of this study was to evaluate the diagnostic value of NETs-related indicators (citH3, cfDNA, and MPO-DNA) as noninvasive fibrosis markers in patients with untreated chronic hepatitis B.

A total of 186 patients with chronic hepatitis B and 56 healthy controls were included in this study. The Ishak scoring system was used to determine the fibrosis stage. NETs-related markers were measured by enzyme-linked immunosorbent assay (ELISA), and the relationship between NETs marker levels and inflammation and fibrosis was analyzed. The diagnostic value of NETs indicators was evaluated by the area under the receiver operating characteristic curve, sensitivity, and specificity.

The levels of NETs markers were associated with the activity of liver inflammation. The levels of citH3, cfDNA, and MPO-DNA in the patient group were significantly higher than those in the control group. Additionally, there were differences in the levels of these markers among different fibrosis stages of chronic HBV infection (P < 0.001), with an increase in NETs markers corresponding to higher fibrosis stages. Receiver operating characteristic (ROC) curve analysis showed that the levels of citH3, cfDNA, and MPO-DNA distinguished the patient group from the control group, and the difference was statistically significant (P < 0.001).

Our results suggest that NETs markers can be used as indicators for the assessment of liver fibrosis in patients with chronic HBV infection.

Neutrophil extracellular traps

Hepatitis B virus

Liver fibrosis

Biomarker

© 2025 Published by Elsevier B.V. on behalf of Pan-Arab Association of Gastroenterology.