Normal liver stiffness and influencing factors in healthy children: An individual participant data meta‐analysis

Li, Darrick K.; Khan, Mumtaz; Wang, Zhen; Chongsrisawat, Voranush; Swangsak, Panida; Teufel-Schäfer, Ulrike; Engelmann, Guido; Goldschmidt, Imeke; Baumann, Ulrich; Tokuhara, Daisuke; Cho, Yuki; Rowland, Marion; Mjelle, Anders Batman; Ramm, Grant A.; Lewindon, Peter; Witters, Peter; Cassiman, David; Ciucă, Ioana; Prokop, Larry; Haffar, Samir; Corey, Kathleen E.; Murad, Mohammad Hassan; Furuya, Katryn N.; Bazerbachi, Fateh

doi:10.1111/liv.14658

Cited by 23 publications

(19 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Thirdly, the results obtained from this study may not be applicable to all aetiologies of chronic liver disease as the majority of the patients had either NAFLD or chronic hepatitis B. Finally, the results of this study may not be applicable to the paediatric population, especially when children have been shown to have age-dependent increases in liver stiffness measurement [26,27]. Further studies are needed to investigate the use of FibroTouch in the paediatric population.…”

Section: Plos Onementioning

confidence: 89%

Attenuation parameter and liver stiffness measurement using FibroTouch vs Fibroscan in patients with chronic liver disease

Lai

Wong

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

Background & aim We studied FibroTouch (FT) and Fibroscan (FS) examination results and their repeatability when performed by healthcare personnel of different background. Methods FT and FS examinations were performed on patients with chronic liver disease by two operators, a doctor and a nurse, twice on each patient, at two different time points, independent of each other. Results The data for 163 patients with 1304 examinations was analyzed. There was strong correlation between FT and FS for attenuation parameter (Spearman’s rho 0.76, p<0.001) and liver stiffness measurement (LSM) (Spearman’s rho 0.70, p<0.001). However, FT produced higher value at lower attenuation parameter and LSM, and lower value at higher attenuation parameter and LSM. There was substantial agreement when using 15kPa LSM cut-off, but only moderate agreement when using 10kPa and 20kPa LSM cut-offs and 248dB/m, 268dB/m and 280dB/m attenuation parameter cut-offs. The IQR for attenuation parameter and IQR/median for LSM were significantly lower for FT compared with FS (4dB/m vs 27dB/m, p<0.001, and 10 vs 12, p<0.001, respectively). The intra- and inter-observer reliability of attenuation parameter and LSM using FT and FS were good to excellent with intraclass correlation coefficients 0.89–0.99. FT had shorter examination time (33s vs 47s, p<0.001) and less invalid measurements (0 vs 2, p<0.001). Conclusion Measurements obtained with FT and FS strongly correlated, but significant differences in their absolute values, consistency, examination time and number of invalid measurements were observed. Either device can be used by healthcare personnel of different backgrounds when sufficiently trained.

show abstract

Section: Plos Onementioning

confidence: 89%

Attenuation parameter and liver stiffness measurement using FibroTouch vs Fibroscan in patients with chronic liver disease

Lai

Wong

et al. 2021

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…The same two reviewers assessed the methodological quality of included studies with a discussion between them in case of disagreement. This tool has been previously applied with consistent agreement among reviewers in several studies 19‐27 …”

Section: Methodsmentioning

confidence: 99%

Liver chemistries in glycogenic hepatopathy associated with type 1 diabetes mellitus: A systematic review and pooled analysis

Haffar¹,

Izzy

Habib

et al. 2021

Liver International

Self Cite

View full text Add to dashboard Cite

Background & Aims Glycogenic hepatopathy (GH) in type 1 diabetes‐mellitus (T1DM) is characterized by hepatomegaly and perturbations of liver chemistries (LC) that have not been well studied. Furthermore, misdiagnosis with other hepatic complications of T1DM, such as nonalcoholic fatty liver disease, has been described. We perform a systematic review of biopsy‐proven GH reports in T1DM patients to identify LC patterns. Methods A systematic review identified reports of biopsy‐proven GH in patients with T1DM. We excluded GH with other liver diseases, Mauriac syndrome, or GH without T1DM. Two reviewers screened and extracted studies and assessed their methodological quality. LC elevation magnitude, AST‐to‐ALT ratio, R‐ratio to designate hepatocellular, cholestatic or mixed pattern of hepatic injury, and evolution of transaminases after glycemic control were analyzed. Results A total of 192 patients were included, with median age of 20 years, 73% adults, 66% females, median duration of T1DM before diagnosis 10 years, median adult body mass index 21 kg/m2, median HbA1c 12%, at least one episode of diabetic ketoacidosis 70%, and hepatomegaly 92%. ALT and AST showed moderate‐to‐severe elevation in 78% and 76%, respectively, AST/ALT >1 in 71% and hepatocellular to mixed pattern of hepatic injury in 81%. Transaminase improvement with glycemic control was the rule, regardless of other factors in multilinear regression analysis. Conclusion GH tends to have AST‐predominant elevation with a median of 13 times the upper normal limit and R‐ratio >2, which may distinguish it from other etiologies of AST‐predominant LC elevation, and in the appropriate clinical context, may obviate invasive tests.

show abstract

“…Multiple studies revealed an increase in liver stiffness with age, but the results remain controversial since the association was found to be weak [64,[67][68][69][70]. Thus, Li et al proved a strong association between increasing age and liver stiffness measurements in children ≥3 years [64]. It is most likely that these findings might be related to microstructure, vascular, and metabolic changes that occur during maturation as it was proved on animal models [71,72].…”

Section: The Opportunities and Challenges Of Ultrasound-based Elastog...mentioning

confidence: 99%

“…The importance of elastography methods for assessing liver fibrosis in adult patients is definitely incontestable, but in pediatric populations several challenges are related especially to their age-specific low compliance, resulting in possible invalid elastography measurement (Figures 3 and 4). Multiple confounding factors identified in pediatric populations were reported to influence liver stiffness on elastography, such as age, sedation, hepatic steatosis, or inflammation [64,65]. Hepatic congestion and inflammation, commonly seen in patients with congenital heart diseases and inflammatory liver disorders, might also result in increased liver stiffness unassociated with fibrosis [36,66].…”

Section: The Opportunities and Challenges Of Ultrasound-based Elastog...mentioning

confidence: 99%

“…Hepatic congestion and inflammation, commonly seen in patients with congenital heart diseases and inflammatory liver disorders, might also result in increased liver stiffness unassociated with fibrosis [36,66]. Multiple studies revealed an increase in liver stiffness with age, but the results remain controversial since the association was found to be weak [64,[67][68][69][70]. Thus, Li et al proved a strong association between increasing age and liver stiffness measurements in children ≥3 years [64].…”

Section: The Opportunities and Challenges Of Ultrasound-based Elastog...mentioning

confidence: 99%

See 1 more Smart Citation

Elastography—A Bona Fide Non-Invasive Method for Assessing Non-Alcoholic Fatty Liver Disease in Children

2021

View full text Add to dashboard Cite

Pediatric obesity has become a major public health problem worldwide, resulting in a wide spectrum of systemic complications. Liver disease associated with obesity, also known as nonalcoholic fatty liver disease (NAFLD), is currently the most common chronic liver condition in children. Therefore, its timely and proper diagnosis is essential for preventing further development of cirrhosis. Multiple studies focused on identifying the most accurate non-invasive diagnostic method for liver fibrosis or cirrhosis. Although liver biopsy remains the gold-standard in terms of this hepatopathy, elastography methods emerged as a relatively reliable alternative to liver biopsy. Thus, recent studies revealed the great importance of these non-invasive methods not only in diagnosing pediatric NAFLD, but also in its staging. MRE is commonly considered to have a greater accuracy than ultrasound-based elastography methods, but with lower availability and higher costs. Ultrasound-based elastography methods (transient elastography (TE), p-SWE, and 2-dimensional shear wave elastography (2D-SWE)) were proved to have similar accuracy in NAFLD staging. Nevertheless, multiple confounding factors account for potential challenges when using elastography for liver stiffness measurement, such as age, obesity itself (i.e., BMI), transaminase levels, or portal flow. A potential solution for facing these challenges might be represented by a complex approach based on the combination between elastography, clinical and laboratory findings. Although the studies that assessed the role of elastography in pediatric NAFLD staging are scarce, the current knowledge underlines a crucial role of these techniques taking into account their ability to distinguish between fibrosis degrees, their non-invasive patterns, lower costs and side effects when compared to liver biopsy. Therefore, elastography might become a cornerstone in staging pediatric NAFLD.

show abstract

Normal liver stiffness and influencing factors in healthy children: An individual participant data meta‐analysis

Cited by 23 publications

References 41 publications

Attenuation parameter and liver stiffness measurement using FibroTouch vs Fibroscan in patients with chronic liver disease

Attenuation parameter and liver stiffness measurement using FibroTouch vs Fibroscan in patients with chronic liver disease

Liver chemistries in glycogenic hepatopathy associated with type 1 diabetes mellitus: A systematic review and pooled analysis

Elastography—A Bona Fide Non-Invasive Method for Assessing Non-Alcoholic Fatty Liver Disease in Children

Contact Info

Product

Resources

About