Development and validation of non-invasive models in predicting advanced fibrosis of choledochal cyst

Abstract

Purpose Choledochal cyst patients (CDCs) develop liver fibrosis, especially advanced fibrosis without prompt surgery. This study validated the aspartate aminotransferase (AST)-to- platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) and constructed a model for predicting advanced fibrosis in pediatric CDCs. Methods 330 CDCs (advanced fibrosis: 34, Ludwig staging 3-4; non-advanced fibrosis: 296, Ludwig staging 0-2) between January 2020 and March 2022 were reviewed. The APRI and FIB-4 were validated. Relevant variables were analyzed by backward stepwise logistic regression. Enhanced bootstrap method was used for internal verification with 1000 samples. Results Mean age at operation was 29.42 ± 35.15 months. The AUROCs of APRI and FIB-4 were 0.761 (0.673-0.850) and 0.561 (p = 0.246). An index, APAR (AST to prealbumin ratio), was constructed with AUROC of 0.776 (0.693-0.860). The AUROCs of APAR + APRI and APAR + FIB-4 were 0.791 (0.713-0.869) and 0.782 (0.699-0.865). No significant differences were in the AUROCs of the indices or their combinations. APAR and APRI could be used together to reduce the rate of misdiagnosis. The risk of advanced fibrosis varied from the different APAR and APRI scores. Conclusion Both APAR and APRI were crucial to identify patients at high risk of advanced fibrosis for CDC.