A Prospective Comparison of Noninvasive Methods in the Assessment of Liver Fibrosis and Esophageal Varices in Pediatric Chronic Liver Diseases

Voutilainen, Silja H.; Kivisaari, Reetta; Jalanko, Hannu; Pakarinen, Mikko P.

doi:10.1097/mcg.0000000000000532

Cited by 22 publications

(29 citation statements)

References 27 publications

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“…Although liver stiffness appears to be one of the most promising noninvasive methods reflecting fibrosis stage, it is influenced both by the etiology of liver disease and patient age . Accordingly, the reported cutoffs and AUROC values for pediatric cirrhosis overlap markedly . Previously determined cutoffs for cirrhosis at the time of PE are slightly lower compared to our results .…”

Section: Discussioncontrasting

confidence: 84%

“…The limited number of previous studies analyzing such tests has also included children after failed PE without a systematic longitudinal assessment of postoperative liver histology, rendering the results unreliable. Liver stiffness is considered a useful predictor of fibrosis stage in children with various liver diseases and has been reported to reflect the presence of esophageal and gastric varices after successful PE . A previous study combining patients with both successful and failed PE found an equation based on liver biochemistry accurate in predicting the degree of histologic fibrosis .…”

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confidence: 99%

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Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

et al. 2019

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We investigated noninvasive follow‐up markers for histologic liver fibrosis and portal hypertension (PH) in patients with biliary atresia after successful portoenterostomy (PE). Among children with bilirubin <20 µmol/L after PE (n = 39), Metavir fibrosis stage was evaluated at PE and in follow‐up protocol liver biopsies (n = 83). PH was defined as endoscopically confirmed esophageal varices or thrombocytopenia associated with splenomegaly. The accuracy of liver biochemistry and stiffness in detecting liver fibrosis and PH was analyzed by the area under the receiving operating characteristic curve (AUROC) and multiple regression models. During a median native liver survival of 8.3 years (interquartile range 2.5‐10.8 years), cirrhosis (Metavir F4) had developed in 51% of patients and PH in 54% of patients. Cirrhosis was equally common in all age tertiles of 1.2‐2.1 years (n = 10/27), 3.9‐5.8 years (n = 12/28), and 9.0‐14 years (n = 12/28). In the two oldest age tertiles, histologic liver fibrosis had progressed further in patients with PH than without PH (P < 0.001). PH was accurately predicted by the aspartate aminotransferase‐to‐platelet ratio index (APRI) (cutoff, 0.70; AUROC, 0.92), bile acids (cutoff, 49 µmol/L; AUROC, 0.91), and liver stiffness (cutoff, 16.9 kPa; AUROC, 0.89; P < 0.001 each) across all age tertiles. Liver stiffness was the most accurate predictor of cirrhosis overall (AUROC, 0.82; P < 0.001), whereas bilirubin was >11 µmol/L in the youngest tertile (AUROC, 0.91; P < 0.001), bile acids was >80 µmol/L in the middle tertile (AUROC, 0.81; P = 0.009), and liver stiffness was >24 kPa in the oldest age tertile (AUROC, 0.96; P = 0.002). Conclusion: After successful PE, development of PH associates with progression of liver fibrosis and can be accurately detected by APRI and stiffness. Liver stiffness most accurately identified cirrhosis in older children, whereas biochemical markers of cholestasis closely reflected histologic cirrhosis in younger children.

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Section: Discussioncontrasting

confidence: 84%

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confidence: 99%

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

et al. 2019

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“…The sensitivity, specificity, and AUROC of K‐VaPS for predicting the presence of clinically significant varices, defined as grade 2 or 3 EGV or EGV with variceal bleeding, were 72%, 73%, and 0.77, respectively . The sensitivity, specificity, and AUROC of APRI for predicting the presence of EGV of any size were 100%, 65%, and 0.83, respectively . Although these non‐invasive indices were relatively accurate for predicting the presence of EGV in children, more precise measurement for detecting HR‐EGV was needed.…”

Section: Discussionmentioning

confidence: 99%

“…Demographic characteristics and laboratory, radiological, and clinical data of patients were recorded at the time of endoscopy, including age, sex, platelet count, prothrombin time – international normalized ratio, serum albumin, total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, γ‐glutamyl transferase, hyaluronic acid, and spleen size as measured by ultrasound. Clinical prediction rule (CPR), King's variceal prediction score (K‐VaPS), and APRI were also calculated, as previously reported non‐invasive predictors of portal hypertension and EGV in children. Data are reported as median and interquartile range (IQR).…”

Section: Methodsmentioning

confidence: 99%

Spleen stiffness by 2‐D shear wave elastography is the most accurate predictor of high‐risk esophagogastric varices in children with biliary atresia

Yokoyama¹,

Ishigami²,

Honda³

et al. 2019

Hepatology Research

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Aim Esophagogastric variceal hemorrhage is a cause of poor prognosis in patients with biliary atresia (BA). To prevent variceal hemorrhage, simple and reliable screening methods for high‐risk esophagogastric varices (HR‐EGV) are needed. We evaluated the efficacy of liver stiffness (LS) and spleen stiffness (SS) as measured by 2‐D shear wave elastography (2D‐SWE), which was reported to be more accurate than transient elastography, for detecting HR‐EGV in children with BA. Methods Thirty‐four children with BA were enrolled. Both LS and SS were measured by 2D‐SWE. The presence of large esophageal varices or esophageal varices of any size with red wale marking and/or the presence of gastric varices along the cardia were defined as HR‐EGV. Clinical data were collected and previously reported prediction indices for varices were calculated. Results Liver stiffness and SS were obtained from all patients. Fourteen patients showed HR‐EGV. Significantly different variables between patients with and without HR‐EGV were as follows: spleen diameter (116 mm vs. 95 mm), clinical prediction rule (104.7 vs. 124.7), King's variceal prediction score (78.8 vs. 99.4), aspartic aminotransferase‐to‐platelet ratio index (2.03 vs. 0.98), LS (2.63 m/s vs. 1.87 m/s), and SS (4.44 m/s vs. 3.69 m/s). The highest area under the receiver operating characteristic curve for detecting HR‐EGV was that for SS (0.900), and the cut‐off SS of 4.12 m/s yielded 92.9% sensitivity and 90% specificity. The intraclass correlation coefficient for intra‐observer reproducibility was 0.828. Conclusions Spleen stiffness from 2D‐SWE offered the most accurate predictor of HR‐EGV in BA children.

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“…Recently, TE‐LSM was compared with APRI and P/SZC to predict liver fibrosis and EVs in 99 children with CLD . For the prediction of EVs, APRI showed the best AUROC of 0.832 in comparison with LSM, SZC, or P/SZC with AUROCs of 0.818 ( P < 0.001), 0.795 ( P = 0.001), and 0.760 ( P = 0.004), respectively.…”

Section: Biomarkersmentioning

confidence: 99%

Biomarkers and imaging studies to predict portal hypertension and varices

Lee

2017

Clinical Liver Disease

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A Prospective Comparison of Noninvasive Methods in the Assessment of Liver Fibrosis and Esophageal Varices in Pediatric Chronic Liver Diseases

Abstract: 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.

Cited by 22 publications

References 27 publications

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

Noninvasive Evaluation of Liver Fibrosis and Portal Hypertension After Successful Portoenterostomy for Biliary Atresia

Spleen stiffness by 2‐D shear wave elastography is the most accurate predictor of high‐risk esophagogastric varices in children with biliary atresia

Biomarkers and imaging studies to predict portal hypertension and varices

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