Noninvasive assessment of liver fibrosis in children with chronic hepatitis C: Shear wave elastography and APRI versus liver biopsy

Abstract

Background and study aims: Hepatitis C virus (HCV) is a major cause of chronic hepatitis. Although liver histopathological examination remains the reference standard for liver fibrosis assessment, noninvasive means of assessment such as shear wave elastography (SWE) and aspartate aminotransferase-platelet ratio index (APRI) have been developed to reduce the need for biopsy. We evaluated the efficacy of SWE and APRI versus liver biopsy for liver fibrosis assessment in children with chronic HCV infection.

Patients and methods: Fibrosis staging was performed in 46 children (35 boys, 11 girls; mean age: 15.52 ± 2.71 years) with liver biopsy-proven chronic HCV infection according to the METAVIR system. SWE was performed within 6 months of liver biopsy. APRI scores were calculated using data collected on the day of biopsy.

Results: Eighteen children had no or mild fibrosis (<F2, 39.1%) and 28 had significant fibrosis (≥F2, 60.9%), with a significant difference between the corresponding mean APRI scores (0.43 ± 0.23 vs 1.26 ± 1.24; p = 0.043). The APRI scores exhibited a significant correlation with the METAVIR stage (r = 0.630; p < 0.001). The SWE values were significantly higher in those with significant fibrosis than in those with no or mild fibrosis (10.43 vs 4.26 kPa; p < 0.000). These values exhibited significant correlations with the METAVIR stage and APRI score (r = 0.863 and 0.544, respectively; both p < 0.001). For differentiating significant fibrosis, the sensitivity, specificity and positive and negative predictive values for an APRI cutoff value of 0.62 were 46.43%, 94.4%, 92.9% and 53.1%, respectively, and these values for an SWE cutoff value of 7.6 kPa were 55.88%, 100%, 100% and 44.4%, respectively.

Conclusion: In the clinical assessment of children, the APRI score and SWE can help differentiate between no or mild fibrosis and significant fibrosis. The routine use of SWE and APRI may help decrease the number of liver biopsies performed.

Keywords: Aspartate aminotransferase–platelet ratio index; Hepatitis C virus; Liver biopsy; Liver fibrosis; Shear wave elastography.