Abstract
BackgroundLiver biopsy is the gold standard for detecting the degree of liver fibrosis; however, invasiveness constitutes its main limiting factor in clinical application, so we aimed to evaluate the non-invasive biomarker formulas (APRI and FIB-4) and their modified forms by BMI z-score (M-APRI, M-FIB-4, and B-AST) compared to liver biopsy in the assessment of liver fibrosis in children with chronic liver diseases. Two hundred children aged 6.3 ± 3.8 years (98 males, 102 females) with chronic liver diseases underwent liver biopsy. The stage of fibrosis was assessed according to the METAVIR system for all children, and the following non-invasive biomarker formulas were calculated: APRI, modified APRI (M-APRI: BMI z-score × APRI), Fibrosis-4 index (FIB-4), modified FIB-4 (M-FIB-4: BMI z-score × FIB-4), and B-AST (BMI z-score × AST). The best cutoff value was calculated to detect early fibrosis (F1–F2) from advanced liver fibrosis (F3–F4).ResultsThere were positive correlations between all studied non-invasive biomarker models (APRI, FIB-4, M-APRI, M-FIB-4, B-AST) and fibrosis score as an increase in fibrosis score was associated with an increase in mean ± SD of all studied biomarker formulas. The best cutoff values of non-invasive biomarker models in the diagnosis of early fibrosis (F1–F2) were APRI > 0.96, M-APRI > 0.16, FIB-4 > 0.019, M-FIB-4 > 0.005, and B-AST > −8 with an area under the curve above 0.7 each, while the best cutoff values of non-invasive biomarker models (APRI, M-APRI, FIB-4, M-FIB-4, and B-AST) in the diagnosis of advanced liver fibrosis (F3–F4) were >1.96, >2.2, >0.045, and >0.015, >92.1, respectively, with an area under the curve above 0.8 each.ConclusionAPRI, M-APRI, FIB-4, M-FIB-4, and B-AST are good non-invasive alternatives to liver biopsy in the detection of liver fibrosis in children with chronic liver diseases of different etiologies especially those that include BMI z-scores in their formulas.
Highlights
Liver biopsy is the gold standard for detecting the degree of liver fibrosis; invasiveness constitutes its main limiting factor in clinical application, so we aimed to evaluate the non-invasive biomarker formulas (APRI and Fibrosis-4 index (FIB-4)) and their modified forms by BMI z-score (M-aminotransferase/platelet ratio index (APRI), modified FIB-4 (M-FIB-4), and B-AST) compared to liver biopsy in the assessment of liver fibrosis in children with chronic liver diseases
Behairy et al Egyptian Pediatric Association Gazette (2021) 69:26 screening tools to predict fibrosis. Fibrosis scores such as aspartate aminotransferase/platelet ratio index (APRI) and fibrosis index based on four factors (Fibrosis-4 index, FIB-4) were developed based on the progression of liver pathology to cirrhosis and derived from the Apricot database in patients with chronic hepatitis C virus (HCV) infection [4]
In this study, we aimed at the evaluation of non-invasive serum biomarker fibrosis models (APRI and FIB-4) and their modified forms by BMI z-score (M-APRI, M-FIB-4, and B-AST), compared to liver biopsy to assess liver fibrosis in children with chronic liver diseases
Summary
Liver biopsy is the gold standard for detecting the degree of liver fibrosis; invasiveness constitutes its main limiting factor in clinical application, so we aimed to evaluate the non-invasive biomarker formulas (APRI and FIB-4) and their modified forms by BMI z-score (M-APRI, M-FIB-4, and B-AST) compared to liver biopsy in the assessment of liver fibrosis in children with chronic liver diseases. Behairy et al Egyptian Pediatric Association Gazette (2021) 69:26 screening tools to predict fibrosis Fibrosis scores such as aspartate aminotransferase/platelet ratio index (APRI) and fibrosis index based on four factors (Fibrosis-4 index, FIB-4) were developed based on the progression of liver pathology to cirrhosis and derived from the Apricot database in patients with chronic hepatitis C virus (HCV) infection [4]. In this study, we aimed at the evaluation of non-invasive serum biomarker fibrosis models (APRI and FIB-4) and their modified forms by BMI z-score (M-APRI, M-FIB-4, and B-AST), compared to liver biopsy to assess liver fibrosis in children with chronic liver diseases
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