Abstract
Abstract
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.
Publisher
Springer Science and Business Media LLC
Reference25 articles.
1. Hashmi SS, Bhatti AH, Malik MI, Rana A, Nasir H, Dar SF. et al (2017). Spectrum of histopathological diagnosis in pediatric patients with liver disorders in Pakistan. J Pak Med Assoc.; 67, (2):266-267.
2. Gaballah MA, Elsaid HH, Shaheen EN (2015) Enhanced liver fibrosis test can replace liver biopsy in detection of liver fibrosis in chronic hepatitis C patients. International Journal of Advanced Research 3(4):145–150
3. Ruzman L, Mikolasevic I, Baraba Dekanic K, Milic S, Palcevski G (2018) Advances in diagnosis of chronic liver diseases in pediatric patients. World J Pediatr. 14(6):541–547. https://doi.org/10.1007/s12519-018-0197-8
4. Leung D.H (2017). Hepatic fibrosis scores and serum biomarkers in pediatric hepatology. Clinical Liver Disease; 9(5):125-130, DOI: https://doi.org/10.1002/cld.634.
5. Pokorska-Śpiewak M, Kowalik-Miko B, Aniszewska M, Magdalena P, Magdalena M (2017) Novel serum biomarkers modified by the body mass index z-score for the detection of liver fibrosis and steatosis in children with chronic hepatitis C. BMC Infectious Diseases 17(1):361–368. https://doi.org/10.1186/s12879-017-2462-1