Aspartate Aminotransferase to Platelet Ratio Index Correlates With Hepatic Cirrhosis but Not With Fibrosis in Pediatric Patients With Intestinal Failure

Díaz, Juan José; Gura, Kathleen M.; Roda, Juliana; Perez‐Atayde, Antonio R.; Duggan, Christopher; Jaksic, Tom; Lo, Clifford

doi:10.1097/mpg.0b013e318299fdbd

Cited by 35 publications

(33 citation statements)

References 29 publications

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“…Children who achieved enteral autonomy by the end of the follow up period were slightly older at the time of study inclusion, were more likely to have NEC as the underlying diagnosis, had preserved ICV and significantly longer intra-operatively measured RSB compared with those not achieving autonomy. Conversely, patients cared for at a PIFCon site with an affiliated intestinal/multi-visceral transplant program and those with more advanced liver disease (as evidenced by higher baseline direct and total bilirubin levels and a higher aspartate aminotransferase to platelet ratio (APRI) 23 were less likely to achieve enteral autonomy.…”

Section: Resultsmentioning

confidence: 99%

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study

Khan

Squires

Litman

et al. 2015

The Journal of Pediatrics

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148

105

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Objectives In a large cohort of children with intestinal failure (IF), we sought to determine the cumulative incidence of achieving enteral autonomy and identify patient and institutional characteristics associated with enteral autonomy. Study design A multicenter retrospective cohort analysis from the Pediatric Intestinal Failure Consortium (PIFCon) was performed. IF was defined as severe congenital or acquired gastrointestinal diseases during infancy with PN dependence >60 days. Enteral autonomy was defined as PN discontinuation >3 months. Results 272 infants were followed for a median (IQR) of 33.5(16.2, 51.5) months. Enteral autonomy was achieved in 118(43%); 36(13%) remained PN dependent and 118 (43%) patients died or underwent transplantation. Multivariable analysis identified NEC [OR 95% CI: 2.42 (1.33, 4.47)], care at an IF site without an associated intestinal transplant (ITx) program [OR 2.73 (1.56, 4.78)] and an intact ileocecal valve (ICV) [OR 2.80 (1.63, 4.83)] as independent risk factors for enteral autonomy. A second model (n=144) including only patients with intra-operatively measured residual small bowel length (RSB) found NEC [OR 3.44 (1.36, 8.71)], care at a non-ITx center [OR 6.56 (2.53, 16.98)] and RSB (cm) [OR 1.04 (1.02, 1.06)] to be independently associated with enteral autonomy. Conclusions A substantial proportion of infants with IF can achieve enteral autonomy. Underlying NEC, preserved ICV and longer bowel length are associated with achieving enteral autonomy. It is likely that variations in institutional practices and referral patterns also affect outcomes in children with IF.

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Section: Resultsmentioning

confidence: 99%

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study

Khan

Squires

Litman

et al. 2015

The Journal of Pediatrics

Self Cite

148

105

View full text Add to dashboard Cite

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“…Median residual bowel length was 32 (19.5–40) cm and median serum citrulline level was 9.5 (7.3–11) µmol/L. At initiation of FO all patients had evidence of IFALD as evidenced by a median direct bilirubin (DB) of 3.5 (3.1–7.0) mg/dL and aspartate aminotransferase to platelet ratio (APRI) of 1.06 (0.54–2.34) (19). Demographic, clinical, and laboratory characteristics of the patients studied are presented in Table 1.…”

Section: Resultsmentioning

confidence: 99%

Preservation of Biochemical Liver Function With Low‐Dose Soy‐Based Lipids in Children With Intestinal Failure–Associated Liver Disease

Khan¹,

Fisher²,

Sparks³

et al. 2015

J. pediatr. gastroenterol. nutr.

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Objectives Intestinal failure associated liver disease (IFALD) contributes to significant morbidity in pediatric intestinal failure (IF) patients. However, the use of parenteral nutrition (PN) with a fish oil-based IV emulsion (FO) has been associated with biochemical reversal of cholestasis and improved outcomes. Unfortunately, FO increases the complexity of care: as it can only be administered under FDA compassionate use protocols requiring special monitoring, is not available as a 3-in-1 solution and is more expensive than comparable soy-based lipid formulation (SO). Due to these pragmatic constraints a series of patient families were switched to low-dose (1g/kg/day) SO following biochemical resolution of cholestasis. This study examines if reversal of cholestasis and somatic growth are maintained following this transition. Methods Chart review of all children with IFALD who switched from FO to SO following resolution of cholestasis. Variables are presented as medians (interquartile ranges). Comparisons performed using Wilcoxon signed-rank test. Results 7 patients aged 25.9 (16.2,43.2) months were transitioned to SO following reversal of cholestasis using FO. At a median follow up 13.9 (4.3,50.1) months there were no significant differences between pre- and post-transition serum alanine and aspartate aminotransferases, direct bilirubin, and weight-for-age z-scores. Due to recurrence of cholestasis, one patient was restarted on FO after four months on SO. Conclusions Biochemical reversal of IFALD and growth were preserved after transition from FO to SO in 6/7 (86%) patients. Given the challenges associated with the use of FO, SO may be a viable alternative in select home PN patients.

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“…Liver biopsy remains the gold standard for assessing the stage of hepatic fibrosis or cirrhosis (16, 17), and therefore only the 126 patients who had liver biopsies reviewed at this institution were included in analysis of cirrhotic vs. non-cirrhotic patients. All liver biopsies were read by experienced pediatric liver pathologists.…”

Section: Methodsmentioning

confidence: 99%

Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients

Fullerton

Sparks

Hall

et al. 2016

Journal of Pediatric Surgery

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Purpose Patient selection for transplant evaluation in pediatric intestinal failure is predicated on the ability to assess long-term transplant-free survival. In light of trends towards improved survival of intestinal failure patients in recent decades, we sought to determine if the presence of biopsy-proven hepatic cirrhosis or the eventual achievement of enteral autonomy were associated with transplant-free survival. Methods After IRB approval, records of all pediatric intestinal failure patients (parenteral nutrition (PN) >90 days) treated at a single intestinal failure center from February 2002 to September 2014 were reviewed. Chi-squared, Mann-Whitney, and log-rank testing were performed as appropriate. Results Of 313 patients, 174 eventually weaned off PN. Liver biopsies were available in 126 patients (most common indication was intestinal failure associated liver disease, IFALD), and 23 met histologic criteria for cirrhosis. Transplant-free survival for the whole cohort of 313 patients was 94.7% at 1 year and 89.2% at 5 years. Among patients with liver biopsies, transplant-free survival in cirrhotics vs. non-cirrhotics was 95.5% vs. 94.1% at one year and 95.5% vs. 86.7% at 5 years (P=0.29). Transplant-free survival in patients who achieved enteral autonomy compared with patients who remained PN dependent was 98.2% vs. 90.3% at one year and 98.2% vs. 76.9% at 5 years (P<0.001). There was no association between cirrhosis and eventual enteral autonomy (P=0.88). Conclusions Achieving enteral autonomy was associated with improved transplant-free survival in pediatric intestinal failure patients. There was no association between histopathological diagnosis of cirrhosis and transplant-free survival in the cohort. These data suggest that automatic transplant referral may not be required for histopathological diagnosis of cirrhosis alone, and that ongoing efforts aimed at achievement of enteral autonomy remain paramount in pediatric intestinal failure.

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Aspartate Aminotransferase to Platelet Ratio Index Correlates With Hepatic Cirrhosis but Not With Fibrosis in Pediatric Patients With Intestinal Failure

Cited by 35 publications

References 29 publications

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study

Predictors of Enteral Autonomy in Children with Intestinal Failure: A Multicenter Cohort Study

Preservation of Biochemical Liver Function With Low‐Dose Soy‐Based Lipids in Children With Intestinal Failure–Associated Liver Disease

Enteral autonomy, cirrhosis, and long term transplant-free survival in pediatric intestinal failure patients

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