Assessment of Liver Fibrosis by Transient Elastography in Children with Chronic Hepatitis B Virus Infection

Abstract

Background: This study aimed to investigate the effectiveness of transient elastography (TE) by comparing liver biopsies to assess liver fibrosis in children with chronic hepatitis B (CHB). Methods: A total of 157 CHB children aged 0 - 6 years in China were enrolled in this single-center prospective study. All patients underwent liver stiffness measurement (LSM) by TE and liver biopsy at an interval of less than a week. Results: LSM, aspartate aminotransferase (AST)-platelet ratio index (APRI), and fibrosis-4 score (FIB-4) positively correlated with activity grade and fibrosis stage in children with CHB. The area under receiver operating characteristic curves (AUCs) of LSM for identifying significant (F ≥ 2) and advanced fibrosis (F ≥ 3) were 0.732 and 0.94, the cut-off values were 5.6 kPa and 6.9 kPa, specificity of 75.7% and 91.5%, and sensitivity of 67.4% and 81.3%, respectively. Compared to LSM, the overall diagnostic performance of APRI and FIB-4 for significant and advanced fibrosis was suboptimal with low AUCs and sensitivity. Since LSM, platelet, and Log10HBsAg were independent factors with the fibrosis stages (F < 2 and F ≥ 2) on the liver biopsy, the LPS index was formulated to predict F ≥ 2 by combining LSM, platelet, and Log10HBsAg. The AUC of LPS for F ≥ 2 was increased to 0.792, which was higher than that of LSM (0.732, p < 0.05), with an improved sensitivity (76.6% vs 67.4%).Conclusions: TE represents a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0 - 6 years.