Transient elastography and aspartate aminotransferase to platelet ratio predict liver injury in paediatric intestinal
Maria Hukkinen1, Reetta Kivisaari2, Jouko Lohi3
1Pediatric Liver and Gut Research Group, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Insights
Transient elastography (TE) and AST to platelet ratio (APRI) can predict liver disease in children with intestinal failure (IF). TE better predicts fibrosis, while APRI is more accurate for cholestasis.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Noninvasive Diagnostics
Background:
- Intestinal failure (IF) often necessitates long-term parenteral nutrition (PN), increasing the risk of liver disease in children.
- Liver biopsy is invasive; thus, noninvasive methods to assess IF-related liver histopathology are crucial.
Purpose of the Study:
- To evaluate the diagnostic value of AST to platelet ratio (APRI) and transient elastography (TE) in predicting liver histopathology in pediatric patients with IF.
- To compare the efficacy of TE and APRI in identifying fibrosis, cholestasis, and steatosis.
Main Methods:
- Analysis of 93 liver biopsies from 57 children with PN duration of at least 3 months.
- APRI measurements and TE were performed concurrently with liver biopsies in 46 children.
- Histopathological findings including fibrosis, cholestasis, and steatosis were correlated with APRI and TE values.
Main Results:
- Histological liver abnormalities were common, with 61% showing fibrosis, 25% cholestasis, and 22% steatosis.
- Transient elastography (TE) demonstrated superior performance in predicting overall liver histopathology (AUROC 0.86) compared to APRI (AUROC 0.67).
- TE accurately predicted fibrosis stages (AUROC ≥F1: 0.78, ≥F2: 0.73), while APRI showed better accuracy for detecting cholestasis (AUROC 0.77).
Conclusions:
- Both TE and APRI are valuable noninvasive tools for monitoring liver disease progression in children with IF.
- TE is more effective for assessing liver fibrosis, whereas APRI is more accurate for diagnosing cholestasis.
- These noninvasive methods can aid in clinical decision-making and reduce the need for liver biopsies.
Background & Aims:
We aimed to evaluate the value of AST to platelet ratio (APRI) and transient elastography (TE) as predictors of liver histopathology in children with intestinal failure (IF).
Methods:
Altogether 93 liver biopsies from 57 children with parenteral nutrition (PN) duration ≥3 months were analysed. APRI measurement and TE (n = 46) were performed at the time of biopsy.
Results:
IF was caused by short bowel syndrome in 75% of patients. At the time of liver biopsy, PN dependent patients (n = 42) were younger with longer PN duration compared to those weaned off PN (n = 51) (2.2 vs. 7.6 years, P < 0.001; 26 vs. 10.5 months, P = 0.043). Elevated transaminase or bilirubin levels were found in 51%, splenomegaly in 26%, and oesophageal varices in 3.5%. Histological fibrosis was present in 61% (Metavir stage F1; 27%, F2; 26%, F3-4; 9%), cholestasis in 25% and steatosis in 22% of biopsy specimens. TE was superior to APRI in prediction of any liver histopathology (fibrosis, cholestasis or steatosis) with areas under the receiving operating curve (AUROC) of 0.86 (95% CI 0.74-0.97) and 0.67 (95% CI 0.58-0.78) respectively. For prediction of ≥F1 and ≥F2 fibrosis, AUROC values for TE were 0.78 (95% CI 0.64-0.93) and 0.73 (95% CI 0.59-0.88), whereas APRI did not correlate with fibrosis stages. For detection of histological cholestasis, the AUROC for APRI was 0.77 (95% CI 0.64-0.89).
Conclusions:
Both TE and APRI are promising noninvasive methods for monitoring the development of IF-related liver histopathology. TE values reflected the degree of fibrosis better while APRI detected histological cholestasis more accurately.
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