Transient elastography compared to liver biopsy and morphometry for predicting fibrosis in pediatric chronic liver disease: Does etiology matter?
OBJECTIVE
To evaluate transient elastography (TE) as a noninvasive tool in staging liver fibrosis compared with liver biopsy and morphometry in children with different chronic liver diseases.


METHODS
A total of 90 children [50 with chronic hepatitis C virus (HCV), 20 with autoimmune hepatitis (AIH) and 20 with Wilson disease] were included in the study and underwent liver stiffness measurement (LSM) using TE. Liver biopsies were evaluated for fibrosis, qualitatively, by Ishak score and quantitatively by fibrosis area fraction (FAF) using digital image analysis (morphometry). LSM was correlated with fibrosis and other studied variables using spearman correlation. A stepwise multiple regression analysis was also performed to examine independent factors associated with LSM. Different cut-off values of LSM were calculated for predicting individual fibrosis stages using receiver-operating characteristic curve. Cut-off values with optimal clinical performance (optimal sensitivity and specificity simultaneously) were selected.


RESULTS
The majority of HCV group had minimal activity (80%) and no/mild fibrosis (72%). On the other hand, the majority of AIH group had mild to moderate activity (70%) and moderate to severe fibrosis (95%) and all Wilson disease group had mild to moderate activity (100%) and moderate to severe fibrosis (100%). LSM correlated significantly with both FAF and Ishak scores and the correlation appeared better with the latter (r = 0.839 vs 0.879, P < 0.0001 for both). LSM discriminated individual stages of fibrosis with high performance. Sensitivity ranged from 81.4% to 100% and specificity ranged from 75.0% to 97.2%. When we compared LSM values for the same stage of fibrosis, they varied according to the different etiologies. Higher values were in AIH (16.15 ± 7.23 kPa) compared to Wilson disease (8.30 ± 0.84 kPa) and HCV groups (7.43 ± 1.73 kPa). Multiple regression analysis revealed that Ishak fibrosis stage was the only independent variable associated with higher LSM (P < 0.0001).


CONCLUSIONS
TE appears reliable in distinguishing different stages of liver fibrosis in children. However, its values vary according to the disease type. For that, a disease-specific estimation of cut-off values for fibrosis staging is worthy.
Behairy El-Sayed Behairy, Mostafa Mohamed Sira, El-Sayed Ebrahem Salama, Mohamed Ahmed Abd-Allah, Department of Pediatric Hepatology, National Liver Institute, Menofiya University, Shebin El-koom 32511, Menofiya, Egypt.
Behairy El-Sayed
Bel-S
Behairy
Behairy El-Sayed Behairy, Mostafa Mohamed Sira, El-Sayed Ebrahem Salama, Mohamed Ahmed Abd-Allah, Department of Pediatric Hepatology, National Liver Institute, Menofiya University, Shebin El-koom 32511, Menofiya, Egypt.
Mostafa Mohamed
MM
Sira
Behairy El-Sayed Behairy, Mostafa Mohamed Sira, El-Sayed Ebrahem Salama, Mohamed Ahmed Abd-Allah, Department of Pediatric Hepatology, National Liver Institute, Menofiya University, Shebin El-koom 32511, Menofiya, Egypt.
Khaled Refat
KR
Zalata
Behairy El-Sayed Behairy, Mostafa Mohamed Sira, El-Sayed Ebrahem Salama, Mohamed Ahmed Abd-Allah, Department of Pediatric Hepatology, National Liver Institute, Menofiya University, Shebin El-koom 32511, Menofiya, Egypt.
El-Sayed Ebrahem
el-SE
Salama
Behairy El-Sayed Behairy, Mostafa Mohamed Sira, El-Sayed Ebrahem Salama, Mohamed Ahmed Abd-Allah, Department of Pediatric Hepatology, National Liver Institute, Menofiya University, Shebin El-koom 32511, Menofiya, Egypt.
Mohamed Ahmed
MA
Abd-Allah
D000293:Adolescent; D000367:Age Factors; D019540:Area Under Curve; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D054459:Elasticity Imaging Techniques; D005260:Female; D019698:Hepatitis C, Chronic / Q000150:complications / Q000175:diagnosis; D019693:Hepatitis, Autoimmune / Q000150:complications / Q000175:diagnosis; D006527:Hepatolenticular Degeneration / Q000150:complications / Q000175:diagnosis; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging* / Q000473:pathology; D008103:Liver Cirrhosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index
Autoimmune hepatitis; Chronic hepatitis C; Liver fibrosis; Liver stiffness; Morphometry; Pediatrics; Transient elastography; Wilson disease