Aim: to evaluate Liver stiffness measurement LSM and aspartate transaminase to platelet ratio APRI score as non invasive means of fibrosis assessment in children with chronic liver disease.
Methods: Liver biopsy was done for 42 children (20 boys and 22girls with mean age of 11.5 ± 3.9 years) suffering from various chronic liver diseases. The stage of fibrosis was assessed according to METAVIR system. APRI score was calculated for 42 of the children and LSM by transient elastography was performed to each of the children as well as to 18 healthy age and sex matched controls. The correlation between METAVIR fibrosis stage and each of the APRI score and LSM was studied. Cutoff points for differentiation of no or mild fibrosis from significant fibrosis in the group as a whole was calculated for APRI and LSM using ROC curves.
Results: fifteen children had no or mild fibrosis (=F2 METAVIR) (G 2). The mean APRI score of the patients was 0.71 +/- 0.48. It was significantly higher in G2 vs G1 patients (0.71 vs 0.3) and showed significant correlation with METAVIR staging (r= +0.53, P<0.001). At a cut off of 0.58 it had 63%, 73%, 70.4%, 66.7% sensitivity, specificity, PPV and NPV respectively for significant fibrosis. LSM was significantly higher in patients vs controls (38.8 vs 11.1 kPas and P<0.000) and in G2 vs G1 (15.4 vs 6.9 KPas and P<0.000). It showed significant positive correlation with both METAVIR staging and APRI score (r=0.58, 0.69 respectivelyand P<0.001). A cut off of 8.1KPas had a 78%, 73%, 77.8% and 73.3% sensitivity, specificity, PPV and NPV respectively for significant fibrosis.
Conclusion: In children, APRI score and LSM perform reasonably well in fibrosis assessment. Diseases with different etiologies have different cutoff values for significant fibrosis.