Hepatic fibrosis scores and serum biomarkers in pediatric hepatology

Leung, Daniel H.

doi:10.1002/cld.634

Cited by 9 publications

(6 citation statements)

References 33 publications

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“…Hepatic fibrosis scores and serum biomarkers can serve as non-invasive, reproducible, and sensitive screening tools to predict fibrosis. Fibrosis scores such as aspartate aminotransferase/platelet ratio index (APRI) and fibrosis index based on four factors (Fibrosis-4 index, FIB-4) were developed based on the progression of liver pathology to cirrhosis and derived from the Apricot database in patients with chronic hepatitis C virus (HCV) infection [4]. Many of serum fibrosis models have been used to evaluate liver fibrosis and cirrhosis in adults with chronic hepatitis C. However, limited data on their accuracy in pediatric patients is available, and none of them has been fully validated in children [5].…”

Section: Introductionmentioning

confidence: 99%

Comparative study between liver biopsy and non-invasive biomarkers in assessment of hepatic fibrosis in children with chronic liver diseases

Behairy

El-Shimi

Shalan

2021

Egypt Pediatric Association Gaz

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Background Liver biopsy is the gold standard for detecting the degree of liver fibrosis; however, invasiveness constitutes its main limiting factor in clinical application, so we aimed to evaluate the non-invasive biomarker formulas (APRI and FIB-4) and their modified forms by BMI z-score (M-APRI, M-FIB-4, and B-AST) compared to liver biopsy in the assessment of liver fibrosis in children with chronic liver diseases. Two hundred children aged 6.3 ± 3.8 years (98 males, 102 females) with chronic liver diseases underwent liver biopsy. The stage of fibrosis was assessed according to the METAVIR system for all children, and the following non-invasive biomarker formulas were calculated: APRI, modified APRI (M-APRI: BMI z-score × APRI), Fibrosis-4 index (FIB-4), modified FIB-4 (M-FIB-4: BMI z-score × FIB-4), and B-AST (BMI z-score × AST). The best cutoff value was calculated to detect early fibrosis (F1–F2) from advanced liver fibrosis (F3–F4). Results There were positive correlations between all studied non-invasive biomarker models (APRI, FIB-4, M-APRI, M-FIB-4, B-AST) and fibrosis score as an increase in fibrosis score was associated with an increase in mean ± SD of all studied biomarker formulas. The best cutoff values of non-invasive biomarker models in the diagnosis of early fibrosis (F1–F2) were APRI > 0.96, M-APRI > 0.16, FIB-4 > 0.019, M-FIB-4 > 0.005, and B-AST > −8 with an area under the curve above 0.7 each, while the best cutoff values of non-invasive biomarker models (APRI, M-APRI, FIB-4, M-FIB-4, and B-AST) in the diagnosis of advanced liver fibrosis (F3–F4) were >1.96, >2.2, >0.045, and >0.015, >92.1, respectively, with an area under the curve above 0.8 each. Conclusion APRI, M-APRI, FIB-4, M-FIB-4, and B-AST are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis in children with chronic liver diseases of different etiologies especially those that include BMI z-scores in their formulas.

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Section: Introductionmentioning

confidence: 99%

Comparative study between liver biopsy and non-invasive biomarkers in assessment of hepatic fibrosis in children with chronic liver diseases

Behairy

El-Shimi

Shalan

2021

Egypt Pediatric Association Gaz

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“…This striking difference in SOX9 expression might be the result of a different pathogenic mechanism in BA; this distinct fact could prove useful to differentiate BA from other causes of neonatal jaundice. Since biochemical markers are non-specific and do not constitute an aid to diagnosis of BA and liver damage evaluation (29,30), other markers are much needed. The finding of a clear cut-off to differentiate BA from non-BA cases announces the usefulness of SOX9 as a potential tool for evaluating liver damage in BA patients.…”

Section: Discussionmentioning

confidence: 99%

Expression of Protein SOX9 in Biliary Atresia

Arboleda-Bustan

Ribalta

Albert

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives: Biliary atresia (BA) is still an enigmatic disease. Deeper knowledge of its pathophysiology could help develop better treatments. SOX9 regulates bile duct development, liver regeneration and fibrosis; therefore, it could be determinant in characterizing BA liver damage. Aim: To study if there is a SOX9 expression pattern in liver biopsies from BA patients. Methods: Liver biopsies from BA patients (group BA), from age-matched infants without primary hepatic disease (group Control), and from patients with other liver conditions (group OLC) were compared. Expression of SOX9 was checked for: amount, intensity of immunoreaction, localization within ductular structures, perifibrotic epithelial cells, and lobular cells. The scores were added to create a scale from 0 to 11 that allowed group comparison. SOX9 Scale and liver survival were also looked for a correlation. Results: All BA cases had a score >4, while all controls scored <4. OLC livers scored 1 to 8 (3.5 AE 2.0) (P < 0.001 between all groups). A cut-off at 4 had 100% sensitivity and 88.24% specificity to differentiate BA from Controls and from OLC (area under receiver operating characteristic curve: 0.9989 (95% confidence interval: 0.9964-1.000). Strong expression of SOX9 was observed mainly in the nuclei of proliferated ductules of portal spaces and fibrotic bridges. SOX9 Scale score could not be related to liver survival in this study. Conclusion:In BA livers, SOX9 is mainly expressed in reactive ductular epithelium, following a pattern significantly different from that seen in non-BA patients; thus, SOX9 Scale may have a role in the diagnosis of BA.

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“…Each scoring system relies on the progressive development of periportal fibrosis. However, fibrosis in children may assume other patterns, such as chicken wire fibrosis within lobules, perisinusoidal involvement, patchy fibrosis, and more rapid development as in BA [ 89 , 90 ]. Therefore, diagnostic efforts have concentrated on the identification and validation of noninvasive and accurate tools for evaluating fibrosis.…”

Section: Approach To Diagnosismentioning

confidence: 99%

Liver fibrosis in children: a comprehensive review of mechanisms, diagnosis, and therapy

Özdoğan

Arıkan

2023

Clin Exp Pediatr

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Chronic liver disease incidence is increasing among children worldwide due to a multitude of epidemiological changes. Most of these chronic insults to the pediatric liver progress to fibrosis and cirrhosis to different degrees. Liver and immune physiology differs significantly in children from adults. Because most of pediatric liver diseases have no definitive therapy, a better understanding of population and disease-specific fibrogenesis is mandatory. Furthermore, fibrosis development has prognostic significance and often guide treatment. Evaluation of liver fibrosis continues to rely on the gold-standard liver biopsy. However, many high-quality studies put forward the high diagnostic accuracy of numerous diagnostic modalities in this setting. Herein, we summarize and discuss the recent literature on fibrogenesis with an emphasis on pediatric physiology along with a detailed outline of disease-specific signatures, noninvasive diagnostic modalities, and the potential for antifibrotic therapies.

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Hepatic fibrosis scores and serum biomarkers in pediatric hepatology

Abstract: http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/9-5-reading-leung.html a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/9-5-interview-leung.html the interview with the author

Cited by 9 publications

References 33 publications

Comparative study between liver biopsy and non-invasive biomarkers in assessment of hepatic fibrosis in children with chronic liver diseases

Comparative study between liver biopsy and non-invasive biomarkers in assessment of hepatic fibrosis in children with chronic liver diseases

Expression of Protein SOX9 in Biliary Atresia

Liver fibrosis in children: a comprehensive review of mechanisms, diagnosis, and therapy

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