Premium
Normal liver stiffness and influencing factors in healthy children: An individual participant data meta‐analysis
Author(s) -
Li Darrick K.,
Khan Muhammad Rehan,
Wang Zhen,
Chongsrisawat Voranush,
Swangsak Panida,
TeufelSchäfer Ulrike,
Engelmann Guido,
Goldschmidt Imeke,
Baumann Ulrich,
Tokuhara Daisuke,
Cho Yuki,
Rowland Marion,
Mjelle Anders B.,
Ramm Grant A.,
Lewindon Peter J.,
Witters Peter,
Cassiman David,
Ciuca Ioana M.,
Prokop Larry D.,
Haffar Samir,
Corey Kathleen E.,
Murad M.H.,
Furuya Katryn N.,
Bazerbachi Fateh
Publication year - 2020
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.14658
Subject(s) - medicine , transient elastography , confidence interval , steatosis , bayesian multivariate linear regression , sedation , stiffness , surgery , linear regression , liver fibrosis , fibrosis , machine learning , computer science , structural engineering , engineering
Background & Aims Although transient elastography (TE) is used to determine liver stiffness as a surrogate to hepatic fibrosis, the normal range in children is not well defined. We performed a systematic review and individual participant data (IPD) meta‐analysis to determine the range of liver stiffness in healthy children and evaluate the influence of important biological parameters. Methods We pooled data from 10 studies that examined healthy children using TE. We divided 1702 children into two groups: ≥3 years (older group) and < 3 years of age (younger group). Univariate and multivariate linear regression models predicting liver stiffness were conducted. Results After excluding children with obesity, diabetes, or abnormal liver tests, 652 children were analysed. Among older children, mean liver stiffness was 4.45 kPa (95% confidence interval 4.34‐4.56), and increased liver stiffness was associated with age, sedation status, and S probe use. In the younger group, the mean liver stiffness was 4.79 kPa (95% confidence interval 4.46‐5.12), and increased liver stiffness was associated with sedation status and Caucasian race. In a subgroup analysis, hepatic steatosis on ultrasound was significantly associated with increased liver stiffness. We define a reference range for normal liver stiffness in healthy children as 2.45‐5.56 kPa. Conclusions We have established TE‐derived liver stiffness ranges for healthy children and propose an upper limit of liver stiffness in healthy children to be 5.56 kPa. We have identified increasing age, use of sedation, probe size, and presence of steatosis on ultrasound as factors that can significantly increase liver stiffness.