Accuracy of noninvasive methods for the diagnosis of liver fibrosis in children with chronic viral hepatitis

Abstract

Background Liver biopsy is the reference standard for assessing liver fibrosis. Moreover, it is an invasive procedure. Transient elastography (TE) is an accurate, noninvasive method for evaluating liver stiffness as a surrogate of liver fibrosis. The aspartate aminotransferase to platelet ratio index (APRI) and Hyaluronic acid (HA) are noninvasive alternatives to liver biopsy for detecting hepatic fibrosis. This study aimed to identify the accuracy of APRI, HA, and TE concerning liver biopsy in children with chronic viral hepatitis. Methods This cross-sectional study included 50 children, 5–18 years with chronic viral hepatitis B (HBV) or hepatitis C (HCV) who underwent liver biopsy within nine months of laboratory tests, determining APRI & performing TE. Twenty healthy children of age and sex-matching patients were included as a control group for the serum HA levels. Results The histopathological findings of the studied cases showed seven cases with (F0) fibrosis, 36 cases with mild (F1,2), two children with moderate (F3,4), and five children with severe (F5,6). The median (IQR) of steatosis was 4 (three had HCV). When correlating TE, APRI, and HA values in all cases with their laboratory data, there was a positive correlation between ALT and APRI values (P-value = 0.000), a positive correlation between AST and HA values (P-value = 0.02), and a negative correlation between stiffness and APRI. The sensitivity of HA, APRI, and TE compared to fibrosis detected by histopathology was 60.5, 65.1, and 60.5%, and their specificity was 71.4, 57.1, and 85.7%, respectively. TE was significantly higher in a group with (moderate to severe) fibrosis. Conclusion APRI, HA, and TE are good indicators of the presence of fibrosis almost with the same accuracy. TE is the only method to differentiate mild cases from those with significant fibrosis.

A Review of Transient Elastography as a Screening Tool in Pediatric Hepatic Diseases

“…To estimate the accuracy of non-invasive methods for diagnosing liver fibrosis with chronic liver hepatitis, a cross-sectional study was done by [7] for hepatitis B and Hepatitis C patients who underwent liver biopsy within nine months of laboratory tests. They concluded that Transient Elastography was the only method to differentiate mild cases from significant ones.…”

Updated Clinical Guidelines on the Management of Hepatitis C Infection in Children

“…Currently there is no standard recommendation regarding when to use a FibroScan ® 502, Echosens, Paris, France or transient elastography to assess liver fibrosis in children with HCV infection. However, a FibroScan or transient elastography might be another method to assess liver fibrosis before or after treatment with DAAs [ 29 , 30 ] and to differentiate mild cases from those with significant fibrosis in children with chronic viral hepatitis including HBV and HCV [ 31 ].…”

The Combination of Noninvasive Tests and Fibroscan for the Assessment of Liver Fibrosis among Patients with Nonalcoholic Fatty Liver Disease

“…This technique has been used to diagnose liver stiffness and fibrosis in the past (15,16). Thus, monitoring the stiffness of the liver over time can show how some liver disorders, including NASH, progress (17). The fundamental idea behind TE is that a homogenous tissue's elasticity, which is connected with the degree of fibrosis in the liver, determines how quickly a wave propagates through it.…”