Correlation of Liver Stiffness Measurements with AST to Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4) Scores in Pediatric Patients with Hepatitis B or Liver Transplantation

Abstract

Background and Objective: 

Current standard for assessing liver fibrosis is biopsy. However, its invasive nature, cost, and limited sampling are problematic for many patients. Fibroscan is a technology that utilizes transient elastography (TE) to measure liver stiffness (LSM) quickly and non-invasively. TE is a novel method in children and has shown to be a measure of fibrosis. Biomarkers for hepatic fibrosis include the APRI and FIB-4 scores, which are not well-studied in children. Our goal is to correlate APRI and FIB-4 with LSM in children who have hepatitis B (hep B) or have received liver transplants (LT). 

Methods: 

LSM scores of 26 children with hep B and 41 children with LT were retrieved from a research database at Riley Hospital for Children. We then obtained laboratory results closest to the date (+/- 1 year) of their TE. Those results were used to determine APRI and FIB-4 scores. Spearman correlation (rs) was determined between LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in each disease. 

Results: 

Table 1. Spearman Correlations for LSM/APRI, LSM/FIB-4, and APRI/FIB-4 in Hep B and LT 

Disease 

Comparison 

Spearman Correlation (rs) 

Hep B 

LSM 

APRI 

0.321 

LSM 

FIB-4 

0.376 

APRI 

FIB-4 

0.731* 

LT 

LSM 

APRI 

0.303 

LSM 

FIB-4 

0.526* 

APRI 

FIB-4 

0.632* 

*p < 0.05 

Conclusion and Potential Impact: 

The moderate correlation of LSM with FIB-4 in LT shows potential for future clinical use, but the correlations of LSM with APRI in both conditions and the correlation of LSM with FIB-4 in Hep B are weaker. APRI and FIB-4 are strongly correlated in these children. However, additional studies with larger sample sizes should be completed. Because patients with LT and chronic hep B regularly need longitudinal evaluation, finding non-invasive tools are important to ensure compliance and ease.