Abstract
BackgroundThis 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).MethodsThis 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.ResultsThe 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%).ConclusionsTE is a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0–6 years.
Highlights
Hepatitis B virus (HBV) infection is one of the most common causes of chronic liver disease worldwide, especially in China where more than 80 million adults and 37,000 children are affected [1, 2]
All three laboratory and histological parameters were positively correlated with the degree of fibrosis (LSM, r = 0.414, p < 0.001; aminotransferase-platelet ratio index (APRI), r = 0.357, p < 0.001; FIB4, r = 0.277, p < 0.001). These results suggest that the liver stiffness measurement (LSM), APRI, and fibrosis-4 index (FIB-4) are positively associated with the severity of liver inflammation and fibrosis in children with chronic hepatitis B (CHB)
While the specificities of the APRI for the prediction of F ≥ 2 and F ≥ 3 were moderately higher than those of the LSM, both the areas under the receiver operating characteristic curves (AUCs) and sensitivities of the APRI and FIB-4 for F ≥ 2 and F ≥ 3 were lower, especially for F ≥ 3 (Table 2; Fig. 2a and b). These results suggest that the LSM is more reliable than the APRI and FIB-4 for the assessment of advanced liver fibrosis; all three of these parameters were suboptimal for the identification of significant liver fibrosis
Summary
Hepatitis B virus (HBV) infection is one of the most common causes of chronic liver disease worldwide, especially in China where more than 80 million adults and 37,000 children are affected [1, 2]. 25% of adult patients who acquire HBV infection in childhood will develop liver cancer or cirrhosis, both of which are associated with high morbidity and mortality [7]. 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). Compared to LSM, the overall diagnostic performances of APRI and FIB-4 for significant and advanced fibrosis were suboptimal, with low AUCs and sensitivity. Conclusions TE is a promising technology for the diagnosis of advanced fibrosis in CHB children aged 0–6 years
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
