>Annals of Hepatology
>Year 2012, Issue 3
Flores-Calderón J, Morán-Villota S, Ramón-García G, González-Romano B, Bojórquez-Ramos MC, Cerdán-Silva L, Hernández-Frías P
Non-invasive markers of liver fibrosis in chronic liver disease in a group of Mexican children. A multicenter study
Ann Hepatol 2012; 11 (3)
PDF: 82.69 Kb.
Introduction. Identifying liver fibrosis is important to evaluate the severity of liver damage and to establish
a prognosis. Utility of non-invasive markers of liver fibrosis has been proved in adults but there are few reports
in children. The aim of this study was to evaluate Fibrotest® score and APRI suitability to identify
children with liver fibrosis. Material and methods. 68 children with chronic liver disease requiring liver
biopsy were prospectively included from three 3rd-level pediatric hospitals. The same pathologist evaluated
all liver biopsies; fibrosis degree was determined by METAVIR score. Serum samples were obtained to
determine Fibrotest® and APRI. AUROC were used to determine cut-off and differentiate between advanced
fibrosis (METAVIR F3, F4) and no fibrosis (F0). Results. 68 biopsies were evaluated; METAVIR › F3 was
identified in 26 (38%). Non invasive liver fibrosis markers to differentiate between advanced and no fibrosis
were: Fibrotest® AUROC = 0.90 (95% CI 0.77-1.00) (cut-off value 0.35) sensitivity 88.00% (95% CI 68-96) and
specificity 80% (95% CI 29-98); and for APRI AUROC = 0.97 (95% CI 0.92-1.00) (cut-off value 0.82), sensitivity
88% (95% CI 68-96) and specificity = 100% (95% CI 46-100). Conclusion. These results suggest the utility of
Fibrotest® and APRI to identify advanced fibrosis; they can be recommended to select patients for liver
biopsy and during patient follow-up.
||Liver fibrosis, APRI, Fibrotest®, Children.
Leonis MA, Balistreri WF. Evaluation and Management of End Stage Liver Disease in Children. Gastroenterology 2008; 134: 1741-51.
Hanif M, Raza J, Queshi H, Issani Z. Etiology of chronic liver disease in children. J Pak Med Assoc 2004; 53: 199-222.
Mieli-Vergani G, Vergani D. Autoimmune paediatric liver disease. World J Gastroenterol 2008; 14: 3360-67.
Dhawan A, Taylor RM, Cheeseman P, De Silva P, Katsiyiannakis L, Mieli-Vergani G. Wilson’s disease in children: 37 year experience and revised Kings’s score for liver transplantation. Liver Transplant 2005; 11: 441-8.
Bortolotti F, Jara P, Crivellaro C, Hierro P, Cadrobbi P, Frauca E. Outcome of chronic hepatitis B in Caucasian children during a 20-year observation period. J Hepatol 1998; 20: 184-90.
Jonas MM. Hepatitis B and C in children: Current treatment and future strategies. Clin Liver Dis 2006; 10: 133-48.
Schwimmer JB, Behling C, Newbory R, Nievergelt C, Schork NJ, Lavine JE. Histopathology of Pediatric Fatty liver Disease. Hepatology 2005; 42: 641-9.
Regev A, Berho M, Jeffers LJ, Milikowski C, Molina EG, Pyrsopoulos NT, Feng ZZ, et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97: 2614-8.
Lebensztejn DM, Kaczmarski M, Sobaniec-Lotowska M, Barwijuk- Machala M. Blind liver biopsy in children-diagnostic significance and complications in authors’ own material. Med Sci Monit 2000; 6: 1155-8.
Lachaux A, Le Gall C, Chambon M, Regnier F, Loras-Duclaux I, Bouvier R, Pinzaru M, et al. Complications of percutaneous liver biopsy in infants and children. Eur J Pediatr 1995; 154: 621-3.
Azzam RK, Alonso EM, Emerick KM, Whitington PF. Safety of percutaneous liver biopsy in infants less than three months old. J Pediatr Gastroenterol Nutr 2005; 41: 639-43.
Kelleher TB, Afdhal N. Noninvasive assessment of liver fibrosis. Clin Liver Dis 2005; 9: 667-83.
Borroni G, Ceriani R, Cazzaiga M, Tommasini M, Roncalli M, Maltempo C, Felline C, et al. Comparison of simple tests for the non-invasive diagnosis of clinically silent cirrhosis in chronic hepatitis C. Aliment Pharmacol Ther 2006; 24: 797-804.
El-Shakbrawi MH, Mohsen NA, Sherif MM, El-Karaksy HM, Abou-Yosef H, El-Sayed HM, Riad H, et al. Noninvasive assessment of hepatic fibrosis and necroinflammatory activity in Egyptian children with chronic hepatitis C virus infection using FibroTest and ActiTest. Eur J Gastroenterol Hepatol 2010; 22: 946-51.
De Ledinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V, Castera L, et al. Liver Stiffness measurement in children using Fibroscan: Feasibility study and comparison with Fibrotest, aspartate transaminase to platelets radio index, and liver biopsy. J Pediatr Gastroenterol Nutr 2007; 45: 443-50.
Hermeziu B, Messous D, Fabre M, Munteanu M, Baussan C, Bernard O, Poynard T, et al. Evaluation of FibroTest-Acti- Test in children with chronic hepatitis C virus infection. Gastroenterol Clin Biol 2010; 34: 16-22.
Available from: www.biopredictive.com.
Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, Lok AS. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003; 38: 518-26.
Bedosa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996; 24: 289-93.
Loomba R, Sirlin CB, Schwimmer JB, Lavine JE. Advances in pediatric nonalcoholic fatty liver disease. Hepatology 2009; 50: 1282-93.
Lebensztejn DM, Sobaniec-Lotowska ME, Kaczmarski M, Voelker M, Schuppan D. Matrix-derived serum markers in monitoring liver fibrosis in children with chronic hepatitis B treated with interferon alpha. World J Gastroenterol 2006; 12: 3338-43.
Kelleher TB, Afdhal N. Noninvasive Assessment of Liver Fibrosis Clin Liver Dis 2005; 9: 667-83.
Lackner C, Struber G, Liegl B, Leibl S, Ofner P, Bankuti C, Bauer B, et al. Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C. Hepatology 2005; 41: 376-82.
Sebastiani G, Vario A, Guido M, Noventa F, Plebani M, Pistis R, Ferrari A, et al. Stepwise combination algorithms of non-invasive markers to diagnose significant fibrosis in chronic hepatitis C. J Hepatol 2006; 44: 686-93.
Rubio A, Monpoux F, Huguon E, Truchi R, Triolo V, Rosenthal- Allieri MA, Deville A, et al. Noninvasive procedures to evaluate liver involvement in HIV-1 vertically infected children. J Pediatr Gastroenterol Nutr 2009; 49: 599-606
>Annals of Hepatology
>Year 2012, Issue 3