Transient liver elastography in unsedated control children: Impact of age and intercurrent illness

Lewindon, Peter; Balouch, Fariha; Pereira, Tamara N.; Puertolas-Lopez, Mora V; Noble, Charlton; Wixey, Julie A.; Ramm, Grant A.

doi:10.1111/jpc.13151

Cited by 31 publications

(33 citation statements)

References 22 publications

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“…LSM did not vary significantly with gender (female, 4.5 ± 0.2 vs. male, 4.8 ± 0.2 kPa). Children with non-hepatic illnesses had higher LSM (5.2 ± 0.2 kPa) compared to healthy children (4.1 ± 0.1 kPa) [51].…”

Section: Te In Healthy Childrenmentioning

confidence: 88%

Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients

et al. 2018

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Featured Application: In this review we present and discuss the published literature on the use of ultrasound-based liver elastography in children. The published data show that all the available shear wave elastography techniques are feasible and accurate for the assessment of liver fibrosis in children with diffuse liver disease due to several etiologies. For the assessment of focal liver lesions evidences are limited and no conclusion can be drawn so far.Abstract: Studies performed using transient elastography (TE), point shear wave elastography (pSWE) and two-dimensional shear wave elastography (2D-SWE) have shown that these techniques are all feasible and accurate in children for the evaluation of liver fibrosis due to several etiologies. However, for some specific pediatric pathologies, such as biliary atresia, the evidence is still limited. As shown in adults, inflammation is a confounding factor when assessing fibrosis severity and care should be taken when interpreting the results. Due to the scarce comparative data between serological tests and elastography techniques in children, a definite conclusion regarding which is the best cannot be drawn. Neither non-invasive elastographic techniques nor laboratory scores allow determination of the presence and the degree of inflammation, necrosis, iron or copper deposits.

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Section: Te In Healthy Childrenmentioning

confidence: 88%

Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients

et al. 2018

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“…Additionally, most clinicians and patients (or their parents) prefer noninvasive alternatives to determine the presence or absence of cirrhosis, particularly in the pediatric population. Ultrasound‐based, liver elastography appears increasingly promising for monitoring children and adolescents with chronic HCV infection …”

Section: Hcv In the Pediatric Populationmentioning

confidence: 99%

“…Ultrasound-based, liver elastography appears increasingly promising for monitoring children and adolescents with chronic HCV infection. (232)(233)(234)(235)(236) HCV-related liver disease generally progresses more slowly in children and adolescents compared to adults, although disease progression is unpredictable. (191,221,(237)(238)(239) Despite a paucity of data evaluating risk factors for HCV disease progression in the pediatric population, children with comorbid conditions (e.g., obesity with nonalcoholic fatty liver disease, congenital heart disease with elevated right heart pressures, and HIV and/or HBV coinfection) and those receiving hepatotoxic drugs require careful monitoring.…”

Section: Routine Liver Biochemistries At Initial Diagnosis and At Leamentioning

confidence: 99%

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

2020

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“…Reliable noninvasive markers of liver fibrosis would promote performance of interventional clinical trials designed to prolong NL survival in BA while sparing children from the burden and potential risks related to liver biopsies . 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 .…”

Section: Discussionmentioning

confidence: 99%

“…This may relate to the dynamic nature of liver damage and remodeling among infants soon after PE or inherently poor reproducibility of liver stiffness measurement in small babies. As many as two‐thirds of liver stiffness measurements performed among children aged <2 years have been reported to be unreliable …”

Section: Discussionmentioning

confidence: 99%

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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Transient liver elastography in unsedated control children: Impact of age and intercurrent illness

Abstract: TE in unsedated children is feasible from infancy but most reliable after 2 years. Intercurrent illness increases LSM; hence, study context is important when interpreting results.

Cited by 31 publications

References 22 publications

Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients

Current Knowledge in Ultrasound-Based Liver Elastography of Pediatric Patients

Hepatitis C Guidance 2019 Update: American Association for the Study of Liver Diseases–Infectious Diseases Society of America Recommendations for Testing, Managing, and Treating Hepatitis C Virus Infection

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

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