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Indocyanine green clearance's association with liver function in paediatric liver disease
G Ficerai-Garland1, T W Helt2, J Nielsen3
1University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Insights
Indocyanine green (ICG) clearance is linked to liver function in children. This study validates ICG as a potential tool for assessing pediatric liver disease alongside other clinical measures.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Biomarker Validation
Background:
- Indocyanine green (ICG) clearance is a sensitive indicator of liver function.
- Its utility in pediatric populations with liver disease requires validation.
- Assessing liver function in children is crucial for timely diagnosis and management.
Purpose of the Study:
- To evaluate the association between indocyanine green (ICG) plasma disappearance rate (ICG-PDR) and established liver function tests in children.
- To determine if ICG clearance can serve as a reliable biomarker for liver function in pediatric liver disease.
- To explore the potential role of ICG in clinical decision-making for pediatric liver conditions.
Main Methods:
- ICG plasma disappearance rate (ICG-PDR) was measured in pediatric patients with liver disease.
- Mixed linear regression models were employed to analyze the relationship between ICG-PDR and liver function parameters.
- Key liver function tests, including international normalized ratio (INR) and prothrombin-proconvertin clotting time (PP), were assessed.
Main Results:
- The study included 124 children (183 visits), with 60.1% females and 85% having chronic liver disease.
- Median ICG-PDR was 23.9%/min. Significant associations were found between ICG-PDR and INR (β = -0.006) and PP (β = 0.005).
- The findings were primarily based on patients with INR < 2.0, with limited data on acute liver failure.
Conclusions:
- ICG clearance demonstrates a significant association with standard liver function tests in children.
- ICG holds promise as an adjunct biomarker for evaluating pediatric liver disease.
- Further research is warranted to confirm ICG's utility, especially in pediatric patients with elevated INR (>1.4).
Aim:
Indocyanine green (ICG) clearance, a sensitive biomarker for liver function, has not been validated in children. We assessed the association between ICG clearance and liver function in children with liver disease.
Methods:
ICG plasma disappearance rate (ICG-PDR, %/min) was measured in children with liver disease. Mixed linear regression was used to assess the relationship between ICG-PDR and liver function tests (international normalised ratio, INR; prothrombin-proconvertin clotting time, PP).
Results:
We included 124 patients with 183 visits. Of the visits, 60.1% were female, 85% had chronic liver disease and 42.5% were liver transplanted. The most common diseases in those without transplantation were autoimmune disease (18.6%) and biliary atresia (10.9%). Median ICG-PDR was 23.9%/min (interquartile range 15; 30.3). Mixed linear regression showed ICG-PDR was associated with INR (β = -0.006, 95% CI [-0.010, -0.003]) and PP (β = 0.005, 95% CI [0.003, 0.008]). However, only five visits were with patients who had acute liver failure (INR ≥2.0).
Conclusion:
ICG clearance is associated with standard measures of liver function in children. ICG may aid decision-making in paediatric liver disease together with other biochemical measures, imaging and clinical presentation. However, further studies are needed to assess the usefulness of ICG in paediatric patients with INR >1.4.
