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Ischemia-modified albumin levels in children with chronic liver disease
Murat Cakir1, Suleyman Caner Karahan, Ahmet Mentese
1Department of Pediatric Gastroenterology Hepatology and Nutrition, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey.
Insights
Ischemia-modified albumin ratios (IMARs) are elevated in children with chronic liver disease (CLD). Higher IMARs predict advanced fibrosis and poor outcomes in pediatric CLD patients.
Area of Science:
- Biochemistry
- Pediatric Gastroenterology
- Hepatology
Background:
- Ischemia-modified albumin (IMA) correlates with liver failure severity in adults.
- The role of IMA in pediatric chronic liver disease (CLD) is not well-established.
Purpose of the Study:
- To investigate the clinical significance of IMA levels in children with CLD.
- To evaluate IMA's potential as a biomarker for fibrosis and prognosis in pediatric CLD.
Main Methods:
- Compared IMA and IMA to albumin ratios (IMARs) in 33 children with CLD and 33 healthy controls.
- Assessed biochemical parameters, oxidant status, and liver fibrosis (severe fibrosis [SF] defined as stage ≥4).
Main Results:
- Children with CLD had significantly higher IMA and IMARs than controls.
- IMAR positively correlated with the Pediatric End-Stage Liver Disease (PELD) score and fibrosis stage.
- Higher IMARs predicted severe fibrosis, need for liver transplantation, and mortality.
- AUROC analysis showed IMAR's utility in predicting SF (0.78) and adverse outcomes (0.82).
Conclusions:
- IMAR is a valuable biomarker in pediatric CLD.
- IMAR aids in predicting fibrosis progression and patient outcomes.
Background/Aims:
Ischemia-modified albumin (IMA) levels have been shown to correlate with the severity of liver failure in adults. However, the role of IMA levels has not been evaluated in children with chronic liver disease (CLD). We analyzed the clinical significance of IMA levels in children with CLD.
Methods:
Thirty-three children with CLD and 33 healthy children were included in the study. Blood was collected to analyze biochemical parameters, oxidant status, and IMA. Liver biopsies were re-evaluated for liver fibrosis; severe fibrosis (SF) was defined as fibrosis stage ≥4.
Results:
THE IMA AND AND IMA TO ALBUMIN RATIOS (IMARS) WERE SIGNIFICANTLY HIGHER IN CHILDREN WITH CLD THAN IN THOSE WITHOUT (IMA: 0.545±0.095 vs 0.481±0.062, p=0.003; IMAR: 0.152±0.046 vs 0.126±0.018, p=0.04). The IMAR was positively correlated with the pediatric end-stage liver disease score (p=0.03, r=0.503) and fibrosis score (p=0.021, r=0.400). Patients with SF had higher IMARs compared to patients with mild fibrosis (0.181±0.056 vs 0.134±0.025, p=0.003). The area under the receiver operation curve (AUROC) for predicting SF was 0.78 (p=0.006). Using a cutoff ratio value of 0.140, the sensitivity and specificity were 84% and 70%, respectively. The AUROC for predicting the need for liver transplantation and/or death was 0.82 (p=0.013). With a cutoff value of 0.156, the sensitivity and specificity was 83% and 82%, respectively. Kaplan-Meier analysis revealed increased morbidity and/or mortality in the group with an IMAR>0.156 (50% vs 4.3%, p=0.005).
Conclusions:
IMARs have been shown to provide important clues in predicting the fibrosis stage of the disease and determining the outcome in children with CLD.
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