Hepatic Inflammation May Influence Liver Stiffness Measurements by Transient Elastography in Children and Young Adults

Abstract

Objectives Transient elastography (TE) measures liver stiffness to assess fibrosis. Studies in adults have shown that inflammation increases stiffness, leading to an overestimation of fibrosis. We investigated the contribution of inflammation to liver stiffness measurements (LSM) in children/young adults. Methods This was a cohort analysis of children/young adults who underwent TE within 1 year of liver biopsy. ALT was obtained within 30d of the biopsy and LSM. Fibrosis was assessed by METAVIR stage and inflammation by ALT and Ishak score. Data were stratified into METAVIR F0–F2 vs. F3–F4. Change between ALT and LSM over time was also assessed. Results 154 patients (50% male) age 3wk to 24y (18% <3 years) were studied. Diagnoses included autoimmune (N=38, 25%), viral (N=25, 16%), cholestasis (N=17, 11%), fatty liver (N=9, 6%), biliary atresia (N=8, 5%), metabolic (N=5, 3%), allograft rejection (N=4, 3%), and other (N=48, 31%). 34% of patients had F3–F4. In patients with F0–F2, the proportion of those with LSM >8.6kPa increased with increasing ALT (P=0.002). In patients with F3–F4, there was no association between ALT and LSM (P=0.17). A correlation between change in ALT and LSM was observed in patients with no/minimal fibrosis and inflammatory liver diseases (r=0.33). Conclusions In children with no/minimal hepatic fibrosis and inflammatory liver disease, high ALT values are associated with LSM in the range typical of advanced fibrosis. However, with more advanced fibrosis, inflammation does not appear to contribute to LSM. Caution must be taken when interpreting LSM for assessing fibrosis severity in the setting of inflammation.

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

“…Previously determined cutoffs for cirrhosis at the time of PE are slightly lower compared to our results . Because histologic inflammation and cholestasis are prominent at PE and both may influence liver stiffness, results obtained at the time of initial surgery are not directly comparable to the postoperative period after COJ. Further, the published BALF score based on albumin, GGT, and bilirubin reflecting follow‐up fibrosis stage in an unselected sample of patients with BA showed no diagnostic accuracy in our cohort comprising solely patients with successful PE .…”

Perspectives on youth‐onset nonalcoholic fatty liver disease

“…103 However, another paediatric study showed that the presence of liver inflammation might overestimate the liver stiffness measurement by TE in children with early fibrosis stages. 104 One of the most sensitive techniques in children is magnetic resonance (MR)-based techniques. Regarding hepatic steatosis quantification, MR-spectroscopy-proton density fat fraction (MRS-PDFF) and MRI-PDFF have shown to be very accurate and reliable methods in children.…”

Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients

“…However, with more advanced fibrosis, inflammation did not appear to contribute to LSM. Caution must be taken when interpreting LSM for assessing fibrosis severity in the setting of inflammation [11].…”