title: Predictors of Liver Disease Severity in Children with Chronic Hepatitis B.
abstract: BACKGROUND
  Evaluation of the liver histology is essential for the management of chronic hepatitis B (CHB) in children.
  
  
  OBJECTIVE
  The aim of this study was to analyze the histopathological features in children with CHB and compare them with clinical and laboratory data.
  
  
  METHODS
  The study comprised 30 treatment-naïve children (mean age: 12.8 ± 2.4; mean duration of infection: 11.7 ± 2.5 years; 16/30 HBeAg-positive and 14/30 HBeAg-negative), who underwent a liver biopsy due to CHB. Liver biopsies were evaluated according to the modified Knodell score.
  
  
  RESULTS
  A histopathological evaluation revealed mild to severe necroinflammatory activity (mean grading: 5.4 ± 3.2) and fibrosis (mean staging: 1.7 ± 0.9), irrespective of the HBeAg-status, viral load and duration of infection. One case of cirrhosis was observed. A multiple regression analysis revealed that alanine and aspartate aminotransferase (ALT and AST) levels were associated with the necroinflammatory activity (p = 0.001 for ALT, and p = 0.006 for AST). No such correlation for fibrosis was observed; however, children with elevated AST were prone to more advanced fibrosis compared to children with normal AST level (p = 0.01).
  
  
  CONCLUSIONS
  Children with CHB presented a wide range of liver changes over a decade after the infection. The severity of liver lesions did not differ according to the HBeAg status, viral load and duration of the infection. ALT and AST levels correlated positively with the inflammatory activity. AST seems to be a better predictor of fibrosis compared to ALT. Liver biopsy is a useful tool in evaluating the severity of liver disease in children with chronic hepatitis B, whereas clinical and laboratory parameters are weak predictors of liver injury.
authors.affiliation: Department of Children's Infectious Diseases, Medical University of Warsaw, Poland.|Hospital of Infectious Diseases, Warszawa, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Pokorska-Śpiewak
authors.affiliation: Department of Children's Infectious Diseases, Medical University of Warsaw, Poland.|Hospital of Infectious Diseases, Warszawa, Poland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Kowalik-Mikołajewska
authors.affiliation: Department of Children's Infectious Diseases, Medical University of Warsaw, Poland.|Hospital of Infectious Diseases, Warszawa, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Aniszewska
authors.affiliation: Department of Children's Infectious Diseases, Medical University of Warsaw, Poland.|Hospital of Infectious Diseases, Warszawa, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Pluta
authors.affiliation: Department of Public Health, Medical University of Warsaw, Poland.
authors.forename: Bożena
authors.initials: B
authors.lastname: Walewska-Zielecka
authors.affiliation: Department of Children's Infectious Diseases, Medical University of Warsaw, Poland.|Hospital of Infectious Diseases, Warszawa, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Marczyńska
mesh_terms: D000293:Adolescent; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D002648:Child; D005260:Female; D005355:Fibrosis / Q000473:pathology; D019694:Hepatitis B, Chronic / Q000473:pathology*; D006801:Humans; D008099:Liver / Q000473:pathology; D008111:Liver Function Tests; D008297:Male; D012189:Retrospective Studies
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase
keywords: children; chronic hepatitis; grading and staging; hepatitis B virus; liver biopsy