Role of transient elastography and APRI in the assessment of pediatric cystic fibrosis liver disease

Jessica P Woolfson; Richard A Schreiber; Shraavan Raveendran; Mark Chilvers; Collin Barker; Orlee R Guttman

doi:10.3138/canlivj-2020-0008

Role of transient elastography and APRI in the assessment of pediatric cystic fibrosis liver disease

Can Liver J. 2021 Feb 24;4(1):23-32. doi: 10.3138/canlivj-2020-0008. eCollection 2021 Winter.

Authors

Jessica P Woolfson^{1

2}, Richard A Schreiber^{1

2}, Shraavan Raveendran², Mark Chilvers^{2

3}, Collin Barker^{1

2}, Orlee R Guttman^{1

2}

Affiliations

¹ Division of Gastroenterology, Hepatology and Nutrition, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
² University of British Columbia, Vancouver, British Columbia, Canada.
³ Division of Respiratory Medicine, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.

Abstract

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.

Keywords: cystic fibrosis-associated liver disease; liver fibrosis; non-invasive; pediatric Author Affiliation; transient elastography.