Assessment of liver fibrosis by transient elastography in young children with chronic hepatitis B virus infection

Abstract

Background This study aimed to compare the diagnostic accuracy of transient elastography (TE) and biopsy for the detection of liver fibrosis in children with chronic hepatitis B (CHB). Methods This single-center prospective study included 157 CHB children aged 0–6 years. All patients underwent liver stiffness measurement (LSM) by TE and liver biopsy, separated by an interval of less than 1 week. Results The LSM, aspartate aminotransferase-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) were positively correlated with activity grade and fibrosis stage in CHB children. The areas under the receiver operating characteristic curves (AUCs) of LSM for identifying significant (F ≥ 2) and advanced (F ≥ 3) fibrosis were 0.732 and 0.941, respectively. The cut-off values, specificity, and sensitivity for significant fibrosis were 5.6 kPa, 75.7%, and 67.4%, respectively; the corresponding values for advanced fibrosis were 6.9 kPa, 91.5%, and 81.3%, respectively. Compared to LSM, the overall diagnostic performances of APRI and FIB-4 for significant and advanced fibrosis were suboptimal, with low AUCs and sensitivity. Since LSM, platelet, and Log10 (hepatitis B surface antigen) were independent factors associated with the fibrosis stage (F < 2 and F ≥ 2), they were used to formulate the “LPS” index for the prediction of F ≥ 2. The AUC of LPS (for F ≥ 2) was higher than that of LSM (0.792 vs. 0.732, p < 0.05), and had an improved sensitivity (76.6% vs. 67.4%). Conclusions TE is a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0–6 years.

Accuracy of noninvasive methods for the diagnosis of liver fibrosis in children with chronic viral hepatitis

“…TE outperformed any indirect measures concerning specificity, PPV, NPV, and overall accuracy correlated to advanced fibrosis [20]. In addition, the results disagreed with Xu et al (2021), who found that APRI did not provide additional advantages over TE for discriminating hepatic fibrosis stages (F ≥ 2 and F ≥ 3) in chronic HBV children [19]. Luo et al (2022) studied the assessment of liver fibrosis by TE and multi-parameters model in young children with chronic hepatitis B virus infection.…”

“…TE outperformed HA in predicting any degree of fibrosis[18]. Similarly, Xu et al (2021) assessed liver fibrosis by TE in 157 young children (0-6 years) with chronic HBV and found that APRI did not provide additional advantages over stiffness for determining hepatic fibrosis stages(F ≥ 2 and F ≥ 3) and concluded that TE was a promising technique for diagnosing advanced fibrosis in chronic HBV children aged 0-6 years[19]. Furthermore, Lee et al (2013) evaluated and compared the ability of HA and TE to predict advanced hepatic fibrosis in 128 patients (pediatrics and young adults) and stated that TE outperformed HA in predicting advanced fibrosis…”

Assessment of liver fibrosis by transient elastography and multi-parameters model in young children with chronic hepatitis B virus infection

“…Chang P. E. and others found that the optimal cut-off for LSM diagnostic significant liver fibrosis (F ≥ 2) in adults was 9.0 kPa, whose sensitivity and specificity were 67.4% and 75.4%, respectively [ 18 ]. And a recent study found that the cut-off values (specificity,sensitivity) for significant fibrosis and advanced fibrosis were 5.6 kPa (75.7%, 67.4%), 6.9 kPa (91.5%, 81.3%) respectively in CHB children aged 0–6 years [ 6 ]. The research of Xu ZQ and colleagues showed that the value of LSM increased with age, as the cut-off values for significant liver fibrosis (F ≥ 2) and progressive liver fibrosis (F ≥ 3) in children under 12 years old were 5.8 and 7.0 kPa, respectively, and they were 6.6 and 8.0 kPa for children above 12 years old [ 7 ].…”

“…They were also divided into 5 stages F0, F1, F2, F3, and F4 according to the Scheuer system on pathological staging.The serologic examinations were performed within two weeks after the LB. The sample size in our study was calculated by the formula as follow: Nsp = (Z 1-α/2 × √ se [1] × (1 − se )/0.1) 2 = (1.96 × √0.915 × (1–0.915)/0.1) 2 ≈ 30 [ 6 ].This study was approved by the Ethics Committee of Hunan Children’s Hospital (IRB No. HCHLL-2019004), and obtained the formal written informed consent from all the parents and guardians of the participating children.…”

“…Although there are a lot of researches focused on non-invasive diagnosis models for liver fibrosis in CHB adults, little is about children. A recent study done by Xu et al found that the liver stiffness measurement (LSM), the aspartate aminotransferase (AST)-platelet (PLT) ratio index (APRI), and FIB-4 were positively correlated with the fibrosis stage in CHB children aged 0–6 years old, and displayed the cut-off values of LSM for significant fibrosis and advanced fibrosis as 5.6 kPa, 6.9 kPa, respectively [ 6 ], which was similar to the result of the study by Xu and his colleagues for children under 12 years old but it was different to the results for children above 12 years old [ 7 ]. Ulrike Teufel-Schäfer and his colleagues also found that TE showed a good correlation to the histological findings in children with hepatopathy [ 8 ].…”