Comparison of Noninvasive Methods for the Evaluation of Liver Fibrosis in Children With Chronic Hepatitis C Virus Infection.

Background and aims: This study aimed to analyze liver fibrosis using transient elastography (TE) and serum biomarkers [aspartate transaminase-to-platelet ratio index (APRI) and the fibrosis-4 index (FIB-4)] in children with chronic hepatitis C before antiviral treatment and to compare the results of these noninvasive methods.

Methods: All consecutive patients 3-17 years old treated with direct-acting antivirals for hepatitis C virus infection between August 2019 and July 2024 were included. Evaluation of liver stiffness measurement (LSM) was performed before starting treatment with TE. Liver fibrosis was considered significant if the median LSM was >7 kPa, corresponding to a METAVIR F score of ≥2 points. Simultaneously, TE, APRI and FIB-4 evaluations were performed, and their accuracy in the detection of significant fibrosis and cirrhosis was determined by calculating areas under the receiver operating characteristic curve (AUROC) using the LSM results as a reference.

Results: One hundred fifty patients with a median age of 11 years were included. TE evaluation revealed that 139/150 (92.7%) of the participants presented with normal LSMs (≤7.0 kPa), whereas in the remaining 11/150 (7.3%) participants, significant fibrosis was confirmed, correlating to a score of F2 on the METAVIR scale in 6 (4%), F3 in 2 (1.3%) and F4 in 3 (2%). Among the independent predictors of significant fibrosis were age >10 years and duration of infection >10 years. The median APRI and FIB-4 values were significantly greater in children with significant liver fibrosis on TE evaluation. For detecting significant fibrosis, the AUROC was 0.706 for the APRI and 0.802 for the FIB-4, with cutoff values >0.53 for the APRI and >0.24 for the FIB-4. When the accuracies of the APRI and the FIB-4 for detecting cirrhosis were analyzed, the AUROCs were greater: 0.879 for the APRI, with a cutoff >0.53, and 0.96 for the FIB-4, with a cutoff >0.40.

Conclusion: There is some agreement between the results of biomarker (APRI and FIB-4) and TE evaluation, but with the assumption of lower cutoff thresholds indicating significant fibrosis/cirrhosis than previously validated in adults.