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Transient elastography and aspartate aminotransferase to platelet ratio predict liver injury in paediatric intestinal failure
Author(s) -
Hukkinen Maria,
Kivisaari Reetta,
Lohi Jouko,
Heikkilä Päivi,
Mutanen Annika,
MerrasSalmio Laura,
Pakarinen Mikko P.
Publication year - 2016
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/liv.12887
Subject(s) - transient elastography , gastroenterology , medicine , liver biopsy , cholestasis , histopathology , fibrosis , steatosis , elevated transaminases , biopsy , pathology
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.