Transient elastography and aspartate aminotransferase to platelet ratio predict liver injury in paediatric intestinal failure

Liver Int. 2016 Mar;36(3):361-9. doi: 10.1111/liv.12887. Epub 2015 Jun 25.

Abstract

Background & aims: We aimed to evaluate the value of AST to platelet ratio (APRI) and transient elastography (TE) as predictors of liver histopathology in children with intestinal failure (IF).

Methods: Altogether 93 liver biopsies from 57 children with parenteral nutrition (PN) duration ≥3 months were analysed. APRI measurement and TE (n = 46) were performed at the time of biopsy.

Results: IF was caused by short bowel syndrome in 75% of patients. At the time of liver biopsy, PN dependent patients (n = 42) were younger with longer PN duration compared to those weaned off PN (n = 51) (2.2 vs. 7.6 years, P < 0.001; 26 vs. 10.5 months, P = 0.043). Elevated transaminase or bilirubin levels were found in 51%, splenomegaly in 26%, and oesophageal varices in 3.5%. Histological fibrosis was present in 61% (Metavir stage F1; 27%, F2; 26%, F3-4; 9%), cholestasis in 25% and steatosis in 22% of biopsy specimens. TE was superior to APRI in prediction of any liver histopathology (fibrosis, cholestasis or steatosis) with areas under the receiving operating curve (AUROC) of 0.86 (95% CI 0.74-0.97) and 0.67 (95% CI 0.58-0.78) respectively. For prediction of ≥F1 and ≥F2 fibrosis, AUROC values for TE were 0.78 (95% CI 0.64-0.93) and 0.73 (95% CI 0.59-0.88), whereas APRI did not correlate with fibrosis stages. For detection of histological cholestasis, the AUROC for APRI was 0.77 (95% CI 0.64-0.89).

Conclusions: Both TE and APRI are promising noninvasive methods for monitoring the development of IF-related liver histopathology. TE values reflected the degree of fibrosis better while APRI detected histological cholestasis more accurately.

Keywords: cholestasis; hepatic fibrosis; intestinal failure-associated liver disease; liver biopsy; parenteral nutrition.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aspartate Aminotransferases / blood*
  • Biomarkers / blood
  • Biopsy
  • Child
  • Child, Preschool
  • Elasticity Imaging Techniques*
  • Female
  • Humans
  • Infant
  • Liver / metabolism
  • Liver / pathology*
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / diagnosis*
  • Liver Cirrhosis / etiology
  • Male
  • Non-alcoholic Fatty Liver Disease / blood
  • Non-alcoholic Fatty Liver Disease / diagnosis*
  • Non-alcoholic Fatty Liver Disease / etiology
  • Parenteral Nutrition
  • Platelet Count
  • Predictive Value of Tests
  • Prospective Studies
  • Reproducibility of Results
  • Risk Factors
  • Short Bowel Syndrome / complications*
  • Short Bowel Syndrome / diagnosis
  • Short Bowel Syndrome / therapy

Substances

  • Biomarkers
  • Aspartate Aminotransferases