Non-Invasive Markers of Liver Fibrosis in Children with Chronic Hepatic Disorders

Abstract

Background: The applicability of non-invasive markers for predicting hepatic fibrosis in the pediatric population with chronic liver abnormalities is unclear. Objectives: We investigated the applicability of common non-invasive liver fibrosis parameters for detecting liver fibrosis in children with chronic hepatitis. Methods: This was a double-center study in Amir-Almomenin Hospital of Zabol and Namazi Hospital of Shiraz (2015 - 2017). Liver fibrosis was confirmed by biopsy examination. AST to platelet ratio (APRI), AST to ALT ratio (AAR), and Fibrosis-4 (FIB-4) were evaluated. Results: Out of 47 patients, 23 (48.9%) were females, and 24 (51.1%) were males. The mean age was 9.8 ± 11.3 months. APRI and FIB-4 correlated with fibrosis stages (r = 0.1 and r = 0.2, respectively). APRI showed an AUC of 0.541 for detecting non-advanced fibrosis (stages 0, 1, and 2). AAR and FIB-4 represented AUCs of 0.622 and 0.592 for advanced fibrosis and cirrhosis, respectively. The highest sensitivity of APRI (70%) was obtained at the cut-off point of 0.81 for cirrhosis. The highest specificities for APRI were observed at 0.66 (68%) and 1.37 (68%) for fibrotic stages 0 and 2, respectively. At the thresholds of 0.71 and 0.59, AAR rendered 78% sensitivity and 90% specificity for advanced fibrosis (stages 3 and 4) and no fibrosis (stage = 0), respectively. FIB-4 showed the highest sensitivity and specificity (70% and 60%) at the cut-off point of 0.21 for detecting cirrhosis. Conclusions: APRI, FIB-4, and AAR can be regarded as useful markers in predicting fibrotic transformation in children with various etiologies of chronic hepatitis.