Transient elastography for accurate staging of liver fibrosis and predicting complications in children with
Wojciech Jańczyk1, Wiesława Grajkowska2, Jakub Kmiotek1
1Department of Gastroenterology, Hepatology, Feeding Disorders and Paediatrics, Children's Memorial Health Institute, Warsaw, Poland.
Objectives:
Autoimmune hepatitis (AIH) presents as hepatitis, chronic or acute liver failure. Liver fibrosis may progress to liver cirrhosis. Pharmacological treatment aims to preserve liver function and induce remission. Transient elastography (FibroScan®, TE) has already been applied in many chronic liver diseases for non-invasive liver stiffness/fibrosis assessment. We aimed to evaluate the usefulness of liver stiffness measurement (LSM) in relation to liver fibrosis on biopsy, selected clinical features and laboratory markers of liver function in the largest paediatric AIH cohort studied.
Methods:
We included 86 children with AIH (41 females) with a mean age of 14 years with AIH. Thirty-seven patients were naïve, and 49 had been previously pharmacologically treated. All patients underwent diagnostic or monitoring liver biopsy and LSM on TE. In selected cases, upper gastrointestinal (UGI) endoscopy was performed to search for oesophageal varices (EV). The relationship between LSM and fibrosis stage was analysed statistically. The optimal cut-off values of LSM were calculated to predict individual fibrosis stages and the presence of EV using the area under the receiver operating characteristic curve (AUROC).
Results:
In our study, LSM was highly accurate in assessing fibrosis staging. LSM strongly correlated with liver fibrosis r = 0.81, p < 0.0001. TE discriminated patients with severe fibrosis (F ≥ 3) from others with excellent sensitivity and specificity-AUROC of LSM was 0.95 with an optimal cut-off point of 8.3 kPa. Similar results were produced when analysing naïve and treated patients. In addition, LSM showed prognostic value in predicting EV with AUROC of 0.77.
Conclusions:
TE can be accurately and reliably used in children with AIH to diagnose and monitor liver fibrosis and its complications as portal hypertension. TE may help to identify patients with severe fibrosis who may require UGI surveillance, therapy modifications and possibly liver transplantation.
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