A Prospective Comparison of Noninvasive Methods in the Assessment of Liver Fibrosis and Esophageal Varices in Pediatric Chronic Liver Diseases.
We compared liver stiffness (LS), the aspartate aminotransferase-to-platelet ratio index (APRi), and the platelet-to-spleen size z score ratio (P/SZC) in the prediction of liver fibrosis and esophageal varices in children.



LS, APRi, SZC, and P/SZC were prospectively determined in 99 unselected consecutive children, who underwent liver biopsy for the follow-up of chronic liver disorders. LS was assessed by transient elastography. The spleen size was evaluated as the SD from age-specific and gender-specific normative values. Varices were assessed endoscopically (n=64). Biopsies were staged according to Metavir.



The median patient age was 6.0 (interquartile range, 1.8 to 12.9) years. Underlying diagnoses included intestinal failure (n=31), biliary atresia (n=24), and others (n=44). LS showed the strongest correlation with the fibrosis stage (r=0.639, P<0.001) compared with P/SZC (r=-0.427, P=0.003), APRi (r=0.419, P=0.001), or SZC (r=0.396, P=0.004). LS clearly performed the best in predicting fibrosis with area under the receiver operator curve (AUROC) values of 0.789 [95% confidence interval (CI), 0.698-0.879; P<0.001] for any (Metavir≥1), and 0.831 (95% CI, 0.745-0.918; P<0.001) for significant (Metavir≥2) fibrosis. For the prediction of the presence of esophageal varices, APRi had a higher AUROC of 0.832 (95% CI, 0.730-0.934; P<0.001), when compared with LS, SZC, or P/SZC with AUROCs of 0.818 (95% CI, 0.706-0.930; P<0.001), 0.795 (95% CI, 0.683-0.904; P=0.001), and 0.760 (95% CI, 0.610-0.909; P=0.004), respectively.



LS performed the best in predicting liver fibrosis, whereas APRi had the highest predictive accuracy for esophageal varices. An LS value over 7.7 kPa identified significant liver fibrosis with high accuracy, whereas low APRi ascertained the absence of esophageal varices.
*Pediatric Liver and Gut Research Group Helsinki, Section of Pediatric Surgery, Children's Hospital †HUS Medical Imaging Center, Children's Hospital ‡Department of Pathology, HUSLAB §Pediatric Nephrology and Transplantation, Children's Hospital, University of Helsinki and Helsinki University Hospital, Finland.
Silja
S
Voutilainen
Reetta
R
Kivisaari
Jouko
J
Lohi
Hannu
H
Jalanko
Mikko P
MP
Pakarinen
D001219:Aspartate Aminotransferases / Q000378:metabolism; D001656:Biliary Atresia / Q000175:diagnosis; D001706:Biopsy; D001792:Blood Platelets / Q000378:metabolism; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D054459:Elasticity Imaging Techniques / Q000379:methods*; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006801:Humans; D007223:Infant; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008107:Liver Diseases / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D013154:Spleen / Q000473:pathology
D001219:Aspartate Aminotransferases