Abstract
BackgroundThere is a need for validation of noninvasive alternatives to liver biopsy for the evaluation of fibrosis in children with chronic hepatitis C (CHC). The aim of this study was to evaluate the diagnostic performance of serum biomarkers modified by the body mass index z-score (BMI z-score) for the detection of fibrosis and steatosis in children with CHC.MethodsThirty children aged 9.4 ± 3.7 years (14 males, 16 females) with CHC underwent liver biopsy. Fibrosis was scored using a 5-point METAVIR scale (≥2 = significant fibrosis). For all the children, the following noninvasive markers were calculated: The aspartate transaminase (AST)-to-platelets ratio index (APRI), the modified APRI (M-APRI: BMI z-score × APRI), the Fibrosis-4 index (FIB-4), the modified FIB-4 (M-FIB-4: BMI z-score × FIB-4), and a novel marker, B-AST (BMI z-score × AST). The area under the receiver operator characteristic curve (AUROC) was calculated to detect significant fibrosis and steatosis.ResultsIn the histopathological evaluation, 22/30 (73%) patients presented with fibrosis, and 8/30 (27%) presented with steatosis. For the detection of significant fibrosis, the AUROCs for M-APRI, M-FIB-4 and B-AST were 0.842, 0.823, and 0.848, respectively. For significant steatosis, the AUROCs were more than 0.9 for all markers that included the BMI z-score. B-AST, with a cut-off of 92.8, showed 71% sensitivity and 95% specificity for detecting significant fibrosis. For predicting severe steatosis, B-AST had 100% sensitivity and 92% specificity. Negative values of all three markers that included BMI z-scores excluded all patients with both significant fibrosis and significant steatosis.ConclusionsIncluding the BMI z-score in serum biomarker formulas enhances their diagnostic ability to detect significant fibrosis and steatosis. B-AST may thus act as an effective alternative to liver biopsy.
Highlights
There is a need for validation of noninvasive alternatives to liver biopsy for the evaluation of fibrosis in children with chronic hepatitis C (CHC)
We have shown that in children with CHC, both fibrosis and steatosis were positively associated with the body mass index z-score (BMI z-score) [9, 10]
The CHC diagnosis was established in patients with at least a 6-month history of hepatitis based on elevated alanine and aspartate aminotransferase (ALT and aspartate transaminase (AST)) serum levels and positive anti-Hepatitis C virus (HCV) testing and was confirmed with nucleic acid testing/positive HCV RNA real-time polymerase chain reaction analysis (RTPCR method; Amplicor, Roche; Cobas TaqMan, Roche)
Summary
There is a need for validation of noninvasive alternatives to liver biopsy for the evaluation of fibrosis in children with chronic hepatitis C (CHC). Liver biopsy has been considered a standard method for evaluating liver fibrosis and steatosis in children with chronic hepatitis C (CHC) [1,2,3] It has several limitations: it is invasive and painful, has inter- and intraobserver variability, and is prone to sampling errors [1, 3]. Indirect markers can be identified in routine blood tests and indicate alterations in liver function [5] Such markers include the aspartate transaminase-to-platelets ratio index (APRI) and the Fibrosis-4 index (FIB-4), which have been validated to predict significant fibrosis and cirrhosis in adult patients with chronic HCV infection [5,6,7]. Simple serum biomarkers are widely available, inexpensive, and easy to calculate and provide a desirable alternative to liver biopsy [8]
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