Utility of Noninvasive Serum Biomarkers of Liver Fibrosis in Infants with Biliary Atresia

Abstract

Background: Biliary Atresia (BA) is the most common cause of chronic cholestasis in infants It is a destructive inflammatory obliterative cholangiopathy that affects varying lengths of both intrahepatic and extrahepatic bile ducts. Even after a successful surgery, scarring of the liver can continue, resulting in cirrhosis and its complications. Aim:The aim of this study is to evaluate different serological markers derived from routine investigations in the prediction of liver fibrosis in infants with BA.Methods: This retrospective study included a total of 147 infants with proved diagnosis of BA. We employed six noninvasive scores (FIB-4, FibroQ, King's score, APRI, GUCI and AAR). Liver fibrosis was classified into 5 grades. For further descriptive purpose, we arbitrarily divided fibrosis grades into early (F1, F2 and F3) and advanced (F4 and F5) fibrosis.Results: FIB-4, FibroQ and King's score correlated significantly with fibrosis grade (P values were 0.007 and 0.015 respectively) while there was no significant correlation with other studied scores (P value >0.05). FIB-4, FibroQ and King's score were significantly higher in patients with advanced fibrosis compared to early fibrosis and at cutoff values of 0.0098, 0.0085 and 0.115 respectively they were able to discriminate those with advanced fibrosis with acceptable sensitivity (61.9%-64.3%) and specificity (60.0%-62.9%). Conclusion:FIB-4, FibroQ and King's score, but not APRI, GUCI and AAR, correlated significantly with fibrosis and could predict those with advanced fibrosis with relatively acceptable performance. These markers may be of help in predicting advanced fibrosis and in long term follow up of infants with BA and reduce the need for repeated liver biopsy.

APRI and FIB-4 indices as diagnostic noninvasive scores for prediction of severe fibrosis in patients with biliary atresia

“…In this regard, a study by Behairy et al [46] found that, regarding the performance of FIB-4, the cutoff point to detect early fibrosis (F1-F2) was > 0.019 with AUC 0.750, and to detect advanced fibro-sis (F3-F4), it was > 0.045 with AUC 0.853. These results agree with Elhenawy et al [41], who reported that the AUC of FIB-4 was 0.0098 with AUC 0.644, 61.9% sensitivity, and 61.9% specificity to discriminating advanced fibrosis. More evidence came from the study by Pokorska-Spiewak et al [47], where FIB-4 at a cutoff point of 0.18, with AUC 0.708, 85.7% sensitivity, and 93.7% negative predictive value (NPV), helped in detecting any stage of fibrosis; the cutoff point was 0.09 with AUC 0.586.…”

“…In agreement with our study, Hwang et al [35] noted that both the FIB-4 score and APRI positively correlated with progressing clinical categories and showed good to excellent performances for distinguishing between different clinical categories in the present study. Also, Elhenawy et al [41] stated that APRI and FIB-4 were significantly correlated with fibrosis in BA and were significantly higher in those with advanced fibrosis (Russo F4 and F5), and they stated that these non-invasive serological markers, which are derived from simple routine laboratory tests, may be of help in predicting advanced fibrosis and in longterm follow-up of infants with BA and minimize the need for repeated follow-up liver biopsies. However, previous reports indicate that the FIB-4 score is unreliable for predicting liver fibrosis in BA and other pediatric liver diseases [27,42,43].…”

“…These results agree with Elhenawy et al . [ 41 ], who reported that the AUC of FIB-4 was 0.0098 with AUC 0.644, 61.9% sensitivity, and 61.9% specificity to discriminating advanced fibrosis. More evidence came from the study by Pokorska-Spiewak et al .…”