Use of Noninvasive Biomarker Tests vs. FibroScan for Predicting Significant Fibrosis in Egyptian Pediatric Cancer...

Egyptian children undergoing chemotherapy are at high risk of hepatitis C virus (HCV) infection because of immunosuppression and multiple blood transfusions. This study evaluated liver fibrosis by comparing transient elastography with aminotransferase-to-platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) in pediatric cancer survivors with chronic HCV infection. Fifty-one cancer survivors with chronic HCV infection (median age, 13.5 years) were prospectively recruited from the pediatric oncology and hepatology clinics at Ain Shams University and the National Cancer Institute. All participants underwent noninvasive fibrosis assessment using transient elastography, APRI, and FIB-4, as well as liver function testing, ultrasonography, and liver biopsy when necessary. Based on liver stiffness measurements, patients were classified into group 1 (fibrosis stage F0-F2; 80.4%) or group 2 (fibrosis stage F3-F4; 19.6%). Compared with group 1, group 2 had significantly higher serum bilirubin and alanine aminotransferase (ALT) levels, lower platelet counts, and higher APRI and FIB-4 scores (p<0.05). Liver stiffness was positively correlated with APRI, FIB-4, chemotherapy duration, ALT, ALP, and ferritin (p<0.05). The AUROCs of APRI and FIB-4 for predicting significant fibrosis (F3-F4) were 0.85 and 0.712, respectively. The cutoff values providing the best prediction of mild and severe fibrosis were 0.86 for APRI and 0.52 for FIB-4. APRI was more accurate than FIB-4 for detecting significant fibrosis. In conclusion, APRI and FIB-4 are useful noninvasive alternatives for assessing hepatic fibrosis in resource-limited countries, with APRI being preferable to FIB-4 for detecting significant fibrosis.