Role of transient elastography and APRI in the assessment of pediatric cystic fibrosis liver disease
Diagnosis and monitoring of cystic fibrosis liver disease (CFLD) is challenging. Transient elastography (TE) is a rapid, non-invasive method for assessing liver fibrosis. Its role in detecting fibrosis in CFLD has only begun to be explored. The aspartate aminotransferase to platelet ratio index (APR...
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| Published in | Canadian liver journal Vol. 4; no. 1; pp. 23 - 32 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | English |
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University of Toronto Press
2021
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| Abstract | Diagnosis and monitoring of cystic fibrosis liver disease (CFLD) is challenging. Transient elastography (TE) is a rapid, non-invasive method for assessing liver fibrosis. Its role in detecting fibrosis in CFLD has only begun to be explored. The aspartate aminotransferase to platelet ratio index (APRI) has been validated as a predictor of hepatic fibrosis in other chronic liver diseases. The purpose of this study was to assess the utility of APRI and TE in identifying liver fibrosis in pediatric CF patients.
Patients aged 2-18 years were recruited from the British Columbia Children's Hospital CF clinic. Patients were determined to have CFLD using standard criteria. Charts were reviewed, and each patient underwent TE.
Of the 55 patients included in the study (50.9% male, mean age 11.6 y), 22 (40%) had CFLD. All mean liver enzymes were higher in the CFLD group, notably alanine transaminase (
= 0.031). Mean liver stiffness (LS) and APRI were also higher in the CFLD group (LS: 5.9 versus 4.5 kPa,
= 0.015; APRI: 0.40 versus 0.32,
= 0.119). Linear regression showed a mild positive association between the two (
= 0.386).
TE values were higher among CFLD patients and correlated with APRI values, suggesting that these tools may have clinical applications for identifying and following this population. Further research is needed on a larger scale to determine the relative value and clinical utility of TE and APRI among patients with CFLD. |
|---|---|
| AbstractList | Background: Diagnosis and monitoring of cystic fibrosis liver disease (CFLD) is challenging. Transient elastography (TE) is a rapid, non-invasive method for assessing liver fibrosis. Its role in detecting fibrosis in CFLD has only begun to be explored. The aspartate aminotransferase to platelet ratio index (APRI) has been validated as a predictor of hepatic fibrosis in other chronic liver diseases. The purpose of this study was to assess the utility of APRI and TE in identifying liver fibrosis in pediatric CF patients. Methods: Patients aged 2–18 years were recruited from the British Columbia Children’s Hospital CF clinic. Patients were determined to have CFLD using standard criteria. Charts were reviewed, and each patient underwent TE. Results: Of the 55 patients included in the study (50.9% male, mean age 11.6 y), 22 (40%) had CFLD. All mean liver enzymes were higher in the CFLD group, notably alanine transaminase ( p = 0.031). Mean liver stiffness (LS) and APRI were also higher in the CFLD group (LS: 5.9 versus 4.5 kPa, p = 0.015; APRI: 0.40 versus 0.32, p = 0.119). Linear regression showed a mild positive association between the two ( r
2
= 0.386). Conclusions: TE values were higher among CFLD patients and correlated with APRI values, suggesting that these tools may have clinical applications for identifying and following this population. Further research is needed on a larger scale to determine the relative value and clinical utility of TE and APRI among patients with CFLD. Diagnosis and monitoring of cystic fibrosis liver disease (CFLD) is challenging. Transient elastography (TE) is a rapid, non-invasive method for assessing liver fibrosis. Its role in detecting fibrosis in CFLD has only begun to be explored. The aspartate aminotransferase to platelet ratio index (APRI) has been validated as a predictor of hepatic fibrosis in other chronic liver diseases. The purpose of this study was to assess the utility of APRI and TE in identifying liver fibrosis in pediatric CF patients. Patients aged 2-18 years were recruited from the British Columbia Children's Hospital CF clinic. Patients were determined to have CFLD using standard criteria. Charts were reviewed, and each patient underwent TE. Of the 55 patients included in the study (50.9% male, mean age 11.6 y), 22 (40%) had CFLD. All mean liver enzymes were higher in the CFLD group, notably alanine transaminase ( = 0.031). Mean liver stiffness (LS) and APRI were also higher in the CFLD group (LS: 5.9 versus 4.5 kPa, = 0.015; APRI: 0.40 versus 0.32, = 0.119). Linear regression showed a mild positive association between the two ( = 0.386). TE values were higher among CFLD patients and correlated with APRI values, suggesting that these tools may have clinical applications for identifying and following this population. Further research is needed on a larger scale to determine the relative value and clinical utility of TE and APRI among patients with CFLD. BackgroundDiagnosis and monitoring of cystic fibrosis liver disease (CFLD) is challenging. Transient elastography (TE) is a rapid, non-invasive method for assessing liver fibrosis. Its role in detecting fibrosis in CFLD has only begun to be explored. The aspartate aminotransferase to platelet ratio index (APRI) has been validated as a predictor of hepatic fibrosis in other chronic liver diseases. The purpose of this study was to assess the utility of APRI and TE in identifying liver fibrosis in pediatric CF patients. MethodsPatients aged 2-18 years were recruited from the British Columbia Children's Hospital CF clinic. Patients were determined to have CFLD using standard criteria. Charts were reviewed, and each patient underwent TE. ResultsOf the 55 patients included in the study (50.9% male, mean age 11.6 y), 22 (40%) had CFLD. All mean liver enzymes were higher in the CFLD group, notably alanine transaminase (p = 0.031). Mean liver stiffness (LS) and APRI were also higher in the CFLD group (LS: 5.9 versus 4.5 kPa, p = 0.015; APRI: 0.40 versus 0.32, p = 0.119). Linear regression showed a mild positive association between the two (r 2 = 0.386). ConclusionsTE values were higher among CFLD patients and correlated with APRI values, suggesting that these tools may have clinical applications for identifying and following this population. Further research is needed on a larger scale to determine the relative value and clinical utility of TE and APRI among patients with CFLD. |
| Author | Woolfson, Jessica P Guttman, Orlee R Raveendran, Shraavan Barker, Collin Schreiber, Richard A Chilvers, Mark |
| AuthorAffiliation | 2 University of British Columbia, Vancouver, British Columbia, Canada 3 Division of Respiratory Medicine, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada 1 Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada |
| AuthorAffiliation_xml | – name: 2 University of British Columbia, Vancouver, British Columbia, Canada – name: 1 Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada – name: 3 Division of Respiratory Medicine, British Columbia Children’s Hospital, Vancouver, British Columbia, Canada |
| Author_xml | – sequence: 1 givenname: Jessica P surname: Woolfson fullname: Woolfson, Jessica P organization: University of British Columbia, Vancouver, British Columbia, Canada – sequence: 2 givenname: Richard A surname: Schreiber fullname: Schreiber, Richard A organization: University of British Columbia, Vancouver, British Columbia, Canada – sequence: 3 givenname: Shraavan surname: Raveendran fullname: Raveendran, Shraavan organization: University of British Columbia, Vancouver, British Columbia, Canada – sequence: 4 givenname: Mark surname: Chilvers fullname: Chilvers, Mark organization: Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada – sequence: 5 givenname: Collin surname: Barker fullname: Barker, Collin organization: University of British Columbia, Vancouver, British Columbia, Canada – sequence: 6 givenname: Orlee R surname: Guttman fullname: Guttman, Orlee R organization: University of British Columbia, Vancouver, British Columbia, Canada |
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| Cites_doi | 10.1097/00004836-200607000-00013 10.1097/MPG.0b013e3181aed725 10.1016/j.jcf.2007.08.001 10.1016/j.ultrasmedbio.2015.11.011 10.1093/jcag/gwy029 10.1097/MPG.0b013e3181da1d98 10.1007/s00431-011-1558-7 10.1002/hep.510230627 10.1097/MPG.0000000000001448 10.1016/j.jpeds.2004.05.051 10.1002/hep.510300527 10.1371/journal.pone.0058955 10.1016/j.cgh.2018.10.046 10.1016/j.bpg.2010.08.003 10.1002/hep.29217 10.1111/liv.12113 10.1097/MPG.0b013e31812e56ff 10.1002/lt.24842 10.1002/hep.1840360613 10.1016/j.jcf.2009.08.001 10.1097/00005176-199707000-00005 10.1371/journal.pone.0205257 10.1002/hep.510270126 10.1016/S1569-1993(11)60006-4 10.1136/gut.2006.111302 10.1016/j.jhep.2008.02.008 10.1002/hep.28016 10.1053/j.gastro.2008.01.034 10.7326/0003-4819-158-11-201306040-00005 10.1016/j.ultrasmedbio.2003.07.001 10.1097/MPG.0b013e31826f2760 10.1016/j.cgh.2019.03.015 10.1007/s00247-009-1531-z 10.1111/jpc.13151 10.3138/canlivj-2018-0019 10.1016/j.jcf.2012.11.010 10.1002/hep.30148 10.1016/j.cgh.2016.03.041 10.1155/2015/138530 |
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| Keywords | transient elastography liver fibrosis cystic fibrosis-associated liver disease non-invasive pediatric Author Affiliation |
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| Title | Role of transient elastography and APRI in the assessment of pediatric cystic fibrosis liver disease |
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