Non-invasive markers of liver fibrosis and cirrhosis in children with biliary atresia

Abstract

Objective. To identify non-invasive laboratory and ultrasound markers of liver fibrosis and cirrhosis in children with biliary atresia. Patients and methods. This retrospective study enrolled 166 children who underwent the Kasai procedure for biliary atresia. Intraoperative liver biopsy followed by histological examination of the biopsy specimen was performed in all children. According to the results of morphological analysis, patients were divided into two groups: group I included 108 children with moderate fibrosis (F0–2), group II – 58 children with severe liver fibrosis/cirrhosis (F3–4). Prior to surgery, patients underwent a comprehensive examination, which included laboratory parameters (platelets, albumin, gamma-glutamyl transpeptidase, cholinesterase, cholesterol, alkaline phosphatase, total and direct bilirubin, alanine aminotransferase, aspartate aminotransferase, fibrinogen, international normalized ratio, thrombin time, prothrombin index, APRI and AAR indices), and Doppler ultrasound. Results. The correlation analysis revealed a statistically significant, direct, very strong correlation between the degree of fibrosis and patient age at the time of biopsy (ρ = 0.805; p < 0.001), APRI index (ρ = 0.827; p = 0.001), and the hepatic artery diameter (ρ = 0.794, p = 0.042). The correlation between the degree of liver fibrosis and spleen length was statistically significant, direct, and of marked strength (ρ = 0.686; p = 0.010). There was a statistically significant, direct, notably strong correlation between the hepatic artery resistive index (RI) (ρ = 0.639; p = 0.05) and hepatic artery diameter-to-portal vein diameter ratio (HAD-to-PVD ratio) (ρ = 0.683, p = 0.047). The dependence of the probability of liver fibrosis/cirrhosis severity on the values of APRI index was assessed using ROC curves. The AUC value was 0.792 ± 0.056 (95% CI: 0.76–0.88, p = 0.009). The APRI value at the cut-off point was 1.52: with an APRI >1.52 showing a high risk of severe liver fibrosis/cirrhosis, and with lower values, the risk of severe fibrosis/cirrhosis was considered low. The sensitivity and specificity of the model were 73.9 and 71.1%, respectively. Conclusion. The results of the study indicate the significance of biochemical, ultrasound and Doppler parameters in the diagnosis of liver fibrosis/cirrhosis in children with biliary atresia. Key words: biliary atresia, liver fibrosis, liver cirrhosis, APRI index