Utility of Aminotransferase/Platelet Ratio Index to Predict Liver Fibrosis in Intestinal Failure–Associated Liver Disease in Pediatric Patients

Rumbo, Carolina; Martínez, M.; Cabanne, Ana; Trentadue, Julio; Fernández, Adriana; Gondolesi, Gabriel

doi:10.1177/0148607115625779

Cited by 15 publications

(14 citation statements)

References 36 publications

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“…In children with biliary atresia, the APRI correlates with degree of fibrosis and predicts postoperative prognosis, but the cut‐points have varied between studies . Rumbo et al demonstrated that an APRI of ≥1.6 predicts advanced liver fibrosis in children with IFALD (sensitivity of 81% and specificity of 76%). In children with hepatocellular and biliary cholestasis, the cut‐points of APRI for discriminating advanced fibrosis were 0.93 (AUC, 0.68) in the hepatocellular group and 2.35 (AUC, 0.81) in the biliary group .…”

Section: Discussionmentioning

confidence: 99%

“…ALT is predominantly expressed in hepatocytes and is associated with the severity of liver disease . The reference value of ALT often quoted for infants aged <12 months is 3–35 IU/L .…”

Section: Discussionmentioning

confidence: 99%

“…Clinically significant fibrosis is defined as fibrosis stage ≥2, and advanced fibrosis is defined as 3 (bridging fibrosis) and/or 4 (cirrhosis) . The rate of progression of PNAC in premature infants is so far unpredictable …”

Section: Introductionmentioning

confidence: 99%

“…In children, the APRI has been studied as a marker of fibrosis and cirrhosis due to chronic liver disease, hepatitis, and biliary atresia . Previous studies correlating the APRI with liver biopsy in children with IFALD found the APRI to correlate well with liver fibrosis . To date, the predictive value of the APRI for PNAC has not been explored in premature infants.…”

Section: Introductionmentioning

confidence: 99%

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Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Vongbhavit

Underwood

2017

J Parenter Enteral Nutr

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Section: Discussionmentioning

confidence: 99%

“…ALT is predominantly expressed in hepatocytes and is associated with the severity of liver disease . The reference value of ALT often quoted for infants aged <12 months is 3–35 IU/L .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Vongbhavit

Underwood

2017

J Parenter Enteral Nutr

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“…Alpha‐fetoprotein is suggested annually in patients with cirrhosis and ammonia in end‐stage IFALD. The aspartate aminotransferase‐to‐platelet index has not been helpful in predicting the degree of fibrosis in children with IFALD but may be useful in predicting cirrhosis …”

Section: Monitoring Of Long‐term Complicationsmentioning

confidence: 99%

Monitoring of long‐term parenteral nutrition in children with intestinal failure

Zemrani

Bines

2019

JGH Open

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Pediatric intestinal failure (IF) is a rare and complex condition associated with significant morbidity and mortality. It is defined as the reduction of gut mass or function below the minimal needed for absorption of nutrients and fluid to sustain life and growth. Since the advent of specialized multidisciplinary intestinal rehabilitation centers, IF management has considerably evolved in the last years, but serious complications of long‐term parenteral nutrition (PN) can occur. Main complications include intestinal failure‐associated liver disease, growth failure, body composition imbalance, central venous access complications, micronutrient deficiencies and toxicities, metabolic bone disease, small intestinal bacterial overgrowth, and renal disease. With improvement in survival rates of patients over the last 20 years, emphasis should be on limiting IF‐related comorbidities and improving quality of life. Close monitoring is pivotal to ensuring quality of care of these patients. The care of children with chronic IF should involve a comprehensive monitoring plan with flexibility for individualization according to specific patient needs. Monitoring of children on long‐term PN varies significantly across units and is mainly based on experience, although few guidelines exist. This narrative review summarizes the current knowledge and practices related to monitoring of children with IF. The authors also share their 20‐year experience at the Royal Children's Hospital in Melbourne Australia on this topic.

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Evaluation of Fibrosis in Intestinal Failure–Associated Liver Disease in the Sustain Registry

Wang

Wamuo

Micic

2020

J Parenter Enteral Nutr

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Background Intestinal failure–associated liver disease (IFALD) is one of the leading complications in type III intestinal failure (IF). Early recognition of liver‐fibrosis development in IFALD is crucial to the development of strategies aimed at reducing the risk of complications secondary to IFALD. Our aim was to identify patients with advanced fibrosis using a noninvasive index and to study the risk factors for fibrosis development in the Sustain registry. Methods Using the Sustain registry, patients requiring >3 months of parenteral nutrition (PN) support were identified. The presence or absence of advanced fibrosis was identified using the Fibrosis‐4 (FIB‐4) index. Risk factors for the presence of a high FIB‐4 score were identified using univariable logistic regression. Results Two hundred seventy‐one adult patients were included. Sixty‐three patients (23.2%) were at risk for advanced fibrosis based on the FIB4‐index. Risk factors for advanced fibrosis included short‐bowel syndrome (odds ratios [ORs]: 1.84; 95% confidence interval [CI], 1.03–3.28), receipt of PN for >1 year (OR: 2.6; 95% CI, 1.46–4.64), receipt of PN for >5 years (OR: 3.05; 95% CI, 1.67–5.59), and days of lipid emulsion use (OR: 1.11; 95% CI, 1–1.24). Small‐intestine–remnant length was inversely associated with advanced fibrosis (OR: 0.97, 95% CI, 0.95–0.99). Conclusion Advanced fibrosis, as guided by FIB‐4 index, is associated with known risk factors for IFALD. Therefore, the FIB‐4 index is potentially a useful noninvasive tool for identification of individuals at risk for fibrosis in IFALD. Further studies utilizing a gold‐standard fibrosis assessment will be required to validate these results.

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Utility of Aminotransferase/Platelet Ratio Index to Predict Liver Fibrosis in Intestinal Failure–Associated Liver Disease in Pediatric Patients

Abstract: APRI in this cohort of patients shows that a score >1.6 correlates with advanced fibrosis.

Cited by 15 publications

References 36 publications

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Predictive Value of the Aspartate Aminotransferase to Platelet Ratio Index for Parenteral Nutrition–Associated Cholestasis in Premature Infants With Intestinal Perforation

Monitoring of long‐term parenteral nutrition in children with intestinal failure

Evaluation of Fibrosis in Intestinal Failure–Associated Liver Disease in the Sustain Registry

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