Usefulness of Transient Elastography for Non-Invasive Diagnosis of Liver Fibrosis in Pediatric Non-Alcoholic Steatohepatitis

Overview

Journal J Korean Med Sci

Specialty General Medicine

Date 2019 Jun 15

PMID 31197983

Citations 9

Authors

Young Dai Kwon

Kyung Ok Ko

Jae Woo Lim

Eun Jung Cheon

Young Hwa Song

Jung Min Yoon

Affiliations

Soon will be listed here.

Abstract

Background: Transient elastography (FibroScan®) is a non-invasive and rapid method for assessing liver fibrosis. While the feasibility and usefulness of FibroScan® have been proven in adults, few studies have focused on pediatric populations. We aimed to determine the feasibility and usefulness of FibroScan® in Korean children.

Methods: FibroScan® examinations were performed in 106 children (age, 5-15 years) who visited the Konyang University Hospital between June and September 2018. Liver steatosis was measured in terms of the controlled attenuation parameter (CAP), while hepatic fibrosis was evaluated in terms of the liver stiffness measurement (LSM). Children were stratified into obese and non-obese controls, according to body mass index (≥ or < 95th percentile, respectively).

Results: The obese group was characterized by significantly higher levels of aspartate aminotransferase (AST, 57.00 ± 48.47 vs. 26.40 ± 11.80 IU/L; < 0.001) and alanine aminotransferase (ALT, 91.27 ± 97.67 vs. 16.28 ± 9.78 IU/L; < 0.001), frequency of hypertension and abdominal obesity (abdominal circumference > 95% percentile) ( < 0.001), CAP (244.4-340.98 dB/m), and LSM (3.85-7.77 kPa) ( < 0.001). On FibroScan®, 30 of 59 obese children had fibrosis (LSM > 5.5 kPa), whereas the remaining 29 did not (LSM < 5.5 kPa). Obese children with fibrosis had higher levels of AST (73.57 ± 56.00 vs. 39.86 ± 31.93 IU/L; = 0.009), ALT (132.47 ± 113.88 vs. 48.66 ± 51.29 IU/L; = 0.001), and gamma-glutamyl transferase (106.67 ± 69.31 vs. 28.80 ± 24.26 IU/L; = 0.042) compared to obese children without fibrosis. LSM had high and significant correlation ( < 0.05) with AST, ALT, homeostasis model assessment for insulin resistance, and AST-to-platelet ratio index.

Conclusion: FibroScan® is clinically feasible and facilitates non-invasive, rapid, reproducible, and reliable detection of hepatic steatosis and liver fibrosis in the Korean pediatric population.

Citing Articles

Prediction of hepatic fibrosis using the aspartate transaminase-to-platelet ratio index in children and adolescents with metabolic dysfunction-associated steatotic liver disease.

Jin H, Noh E, Jeong H, Hwang I BMC Pediatr. 2024; 24(1):788.

PMID: 39614232 PMC: 11607948. DOI: 10.1186/s12887-024-05263-3.

Clinical research of fibroscan ‒ TE-CAP at noninvasive diagnosis of hepatic steatosis in children.

Jia S, Zhou J, Zhang Q, Zhou S, Wang Z, Ye X Clinics (Sao Paulo). 2024; 79:100387.

PMID: 38805982 PMC: 11152890. DOI: 10.1016/j.clinsp.2024.100387.

Clinical epidemiology of non-alcoholic fatty liver disease in children and adolescents. The LiverKids: Study protocol.

Chacon C, Arteaga I, Martinez-Escude A, Rojano I, Lamonja-Vicente N, Caballeria L PLoS One. 2023; 18(10):e0286586.

PMID: 37831682 PMC: 10575486. DOI: 10.1371/journal.pone.0286586.

Prevalence and incidence of MAFLD and associated anthropometric parameters among prepubertal children of the Shanghai Birth Cohort.

Zeng J, Jin Q, Yang J, Yang R, Zhang R, Zhao J Hepatol Int. 2023; 17(6):1416-1428.

PMID: 37728728 DOI: 10.1007/s12072-023-10574-1.

Noninvasive biomarkers in pediatric nonalcoholic fatty liver disease.

Jayasekera D, Hartmann P World J Hepatol. 2023; 15(5):609-640.

PMID: 37305367 PMC: 10251277. DOI: 10.4254/wjh.v15.i5.609.

References

Ratziu V, Giral P, Charlotte F, Bruckert E, Thibault V, Theodorou I . Liver fibrosis in overweight patients. Gastroenterology. 2000; 118(6):1117-23. DOI: 10.1016/s0016-5085(00)70364-7. View

Wai C, Greenson J, Fontana R, Kalbfleisch J, Marrero J, Conjeevaram H . A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology. 2003; 38(2):518-26. DOI: 10.1053/jhep.2003.50346. View

Kunde S, Lazenby A, Clements R, Abrams G . Spectrum of NAFLD and diagnostic implications of the proposed new normal range for serum ALT in obese women. Hepatology. 2005; 42(3):650-6. DOI: 10.1002/hep.20818. View

Sartorio A, Del Col A, Agosti F, Mazzilli G, Bellentani S, Tiribelli C . Predictors of non-alcoholic fatty liver disease in obese children. Eur J Clin Nutr. 2006; 61(7):877-83. DOI: 10.1038/sj.ejcn.1602588. View

Takeda T, Yasuda T, Nakayama Y, Nakaya M, Kimura M, Yamashita M . Usefulness of noninvasive transient elastography for assessment of liver fibrosis stage in chronic hepatitis C. World J Gastroenterol. 2007; 12(48):7768-73. PMC: 4087540. DOI: 10.3748/wjg.v12.i48.7768. View

Pacifico L, Celestre M, Anania C, Paolantonio P, Chiesa C, Laghi A . MRI and ultrasound for hepatic fat quantification:relationships to clinical and metabolic characteristics of pediatric nonalcoholic fatty liver disease. Acta Paediatr. 2007; 96(4):542-7. DOI: 10.1111/j.1651-2227.2007.00186.x. View

de Ledinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V . Liver stiffness measurement in children using FibroScan: feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterol Nutr. 2007; 45(4):443-50. DOI: 10.1097/MPG.0b013e31812e56ff. View

Yoneda M, Mawatari H, Fujita K, Endo H, Iida H, Nozaki Y . Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis. 2007; 40(5):371-8. DOI: 10.1016/j.dld.2007.10.019. View

Roulot D, Czernichow S, Le Clesiau H, Costes J, Vergnaud A, Beaugrand M . Liver stiffness values in apparently healthy subjects: influence of gender and metabolic syndrome. J Hepatol. 2008; 48(4):606-13. DOI: 10.1016/j.jhep.2007.11.020. View

10.

Rockey D, Caldwell S, Goodman Z, Nelson R, Smith A . Liver biopsy. Hepatology. 2009; 49(3):1017-44. DOI: 10.1002/hep.22742. View

11.

Sanchez Antolin G, Garcia Pajares F, Vallecillo M, Fernandez Orcajo P, Gomez de la Cuesta S, Alcaide N . FibroScan evaluation of liver fibrosis in liver transplantation. Transplant Proc. 2009; 41(3):1044-6. DOI: 10.1016/j.transproceed.2009.02.027. View

12.

Feldstein A, Charatcharoenwitthaya P, Treeprasertsuk S, Benson J, Enders F, Angulo P . The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years. Gut. 2009; 58(11):1538-44. PMC: 2792743. DOI: 10.1136/gut.2008.171280. View

13.

Mueller S, Millonig G, Sarovska L, Friedrich S, Reimann F, Pritsch M . Increased liver stiffness in alcoholic liver disease: differentiating fibrosis from steatohepatitis. World J Gastroenterol. 2010; 16(8):966-72. PMC: 2828601. DOI: 10.3748/wjg.v16.i8.966. View

14.

Bellentani S, Scaglioni F, Marino M, Bedogni G . Epidemiology of non-alcoholic fatty liver disease. Dig Dis. 2010; 28(1):155-61. DOI: 10.1159/000282080. View

15.

Gaia S, Carenzi S, Barilli A, Bugianesi E, Smedile A, Brunello F . Reliability of transient elastography for the detection of fibrosis in non-alcoholic fatty liver disease and chronic viral hepatitis. J Hepatol. 2010; 54(1):64-71. DOI: 10.1016/j.jhep.2010.06.022. View

16.

Ruffillo G, Fassio E, Alvarez E, Landeira G, Longo C, Dominguez N . Comparison of NAFLD fibrosis score and BARD score in predicting fibrosis in nonalcoholic fatty liver disease. J Hepatol. 2010; 54(1):160-3. DOI: 10.1016/j.jhep.2010.06.028. View

17.

Kim S, Jang H, Cheong J, Kim J, Lee M, Kim D . The usefulness of liver stiffness measurement using FibroScan in chronic hepatitis C in South Korea: a multicenter, prospective study. J Gastroenterol Hepatol. 2010; 26(1):171-8. DOI: 10.1111/j.1440-1746.2010.06385.x. View

18.

Wong G, W-S Wong V, Chim A, Yiu K, Chu S, Li M . Factors associated with unreliable liver stiffness measurement and its failure with transient elastography in the Chinese population. J Gastroenterol Hepatol. 2011; 26(2):300-5. DOI: 10.1111/j.1440-1746.2010.06510.x. View

19.

Engelmann G, Gebhardt C, Wenning D, Wuhl E, Hoffmann G, Selmi B . Feasibility study and control values of transient elastography in healthy children. Eur J Pediatr. 2011; 171(2):353-60. DOI: 10.1007/s00431-011-1558-7. View

20.

Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U . Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012; 54(5):700-13. DOI: 10.1097/MPG.0b013e318252a13f. View