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Normal liver stiffness and influencing factors in healthy children: An individual participant data meta-analysis

Darrick K Li1, Muhammad Rehan Khan2, Zhen Wang3

  • 1Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.

Liver International : Official Journal of the International Association for the Study of the Liver
|September 9, 2020
PubMed

Insights

Transient elastography (TE) establishes liver stiffness ranges in healthy children, defining normal as 2.45-5.56 kPa. Factors like age, sedation, and steatosis influence these measurements.

Area of Science:

  • Pediatric Gastroenterology
  • Hepatology
  • Medical Imaging

Background:

  • Transient elastography (TE) is crucial for assessing liver fibrosis, but normal liver stiffness ranges in children are not well-established.
  • Accurate reference ranges are needed for reliable pediatric liver health assessment.

Purpose of the Study:

  • To determine the normal range of liver stiffness in healthy children using TE.
  • To identify biological and procedural factors influencing liver stiffness measurements in pediatric populations.

Main Methods:

  • A systematic review and individual participant data (IPD) meta-analysis of 10 studies involving 1702 children.
  • Analysis of 652 children after excluding those with obesity, diabetes, or abnormal liver tests, divided into younger (<3 years) and older (≥3 years) groups.
  • Application of univariate and multivariate linear regression models to identify predictors of liver stiffness.

Main Results:

  • Established a reference range for normal liver stiffness in healthy children as 2.45-5.56 kPa.
  • In older children (≥3 years), mean liver stiffness was 4.45 kPa, influenced by age, sedation, and S probe use.
  • In younger children (<3 years), mean liver stiffness was 4.79 kPa, influenced by sedation and Caucasian race.
  • Hepatic steatosis on ultrasound was significantly associated with increased liver stiffness across groups.

Conclusions:

  • Defined TE-derived liver stiffness ranges for healthy children, proposing an upper limit of 5.56 kPa.
  • Identified key factors influencing liver stiffness measurements in children, including age, sedation, probe type, and hepatic steatosis.
  • Provides essential reference data for pediatric liver health evaluations using TE.
Abstract

Keywords:
FibroScanhealthy controlsliver stiffnesssteatosistransient elastography

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