TY - JOUR
T1 - The prevalence of liver fibrosis according to non-invasive tools in a pediatric home parenteral nutrition cohort
AU - Nagelkerke, Sjoerd C. J.
AU - Draijer, Laura G.
AU - Benninga, Marc A.
AU - Koot, Bart G. P.
AU - Tabbers, Merit M.
N1 - Funding Information: This work was supported by an investigator initiated research grant from the Baxter Healthcare Corporation, Deerfield, IL. Baxter Healthcare Corporation had no role in study design, data collection, data analysis, interpretation of the study results, or writing of the manuscript. M.T. has received an investigator-initiated research grant from the Baxter Healthcare Corporation, Deerfield, IL. M.B. has been a consultant for Shire, Norgine, Tramedico, Allergan, Danone, Novalac, FrieslandCampina, and Sensus, and has received honoraris from Abbott as a speaker. For the remaining authors, none is declared. Publisher Copyright: © 2020 The Author(s)
PY - 2021/2
Y1 - 2021/2
N2 - Background & aims: Liver biopsy is no viable tool to routinely screen for liver fibrosis in children suffering from chronic intestinal failure (IF). We aim to assess the prevalence of liver fibrosis in a cohort of children with chronic IF by non-invasive tests: transient elastography (TE), aspartate-aminotransferase-to-platelet-ratio-index (APRI) and enhanced liver fibrosis (ELF) score. Methods: Cross sectional study where patients with chronic IF, receiving parenteral nutrition (PN) for at least 3 months, were enrolled. TE, APRI and ELF score were measured. Using Spearman's rank correlation coefficient and Kruskal–Wallis H test, the correlation between TE, APRI, ELF score and known risk factors for development of intestinal failure-associated liver disease (IFALD) were calculated. Results: 32 patients were included (50% female), median age was 8 years and 4 months, median PN duration was 45 months. Six patients (21%) had TE ≥6.5 kPa, indicating significant fibrosis. Twelve patients (38%) had APRI ≥.5, indicating fibrosis. ELF score indicated moderate fibrosis in 17 patients (63%) and significant fibrosis in 10 patients (37%). TE and APRI correlated significantly with known risk factors for IFALD, but ELF showed poor correlation with known risk factors for IFALD. Conclusion: In a cohort of pediatric patients suffering from chronic IF, TE measurement, APRI and ELF test show a varying, but substantial proportion of subjects with fibrosis. The diagnostic value of these tests and their role in the management of pediatric IF must be determined in larger cohorts with liver biopsy as reference standard. Trial Registration: Academic Medical Center medical ethics committee number: METC 2017_185.
AB - Background & aims: Liver biopsy is no viable tool to routinely screen for liver fibrosis in children suffering from chronic intestinal failure (IF). We aim to assess the prevalence of liver fibrosis in a cohort of children with chronic IF by non-invasive tests: transient elastography (TE), aspartate-aminotransferase-to-platelet-ratio-index (APRI) and enhanced liver fibrosis (ELF) score. Methods: Cross sectional study where patients with chronic IF, receiving parenteral nutrition (PN) for at least 3 months, were enrolled. TE, APRI and ELF score were measured. Using Spearman's rank correlation coefficient and Kruskal–Wallis H test, the correlation between TE, APRI, ELF score and known risk factors for development of intestinal failure-associated liver disease (IFALD) were calculated. Results: 32 patients were included (50% female), median age was 8 years and 4 months, median PN duration was 45 months. Six patients (21%) had TE ≥6.5 kPa, indicating significant fibrosis. Twelve patients (38%) had APRI ≥.5, indicating fibrosis. ELF score indicated moderate fibrosis in 17 patients (63%) and significant fibrosis in 10 patients (37%). TE and APRI correlated significantly with known risk factors for IFALD, but ELF showed poor correlation with known risk factors for IFALD. Conclusion: In a cohort of pediatric patients suffering from chronic IF, TE measurement, APRI and ELF test show a varying, but substantial proportion of subjects with fibrosis. The diagnostic value of these tests and their role in the management of pediatric IF must be determined in larger cohorts with liver biopsy as reference standard. Trial Registration: Academic Medical Center medical ethics committee number: METC 2017_185.
KW - Enhanced liver fibrosis score
KW - Intestinal failure-associated liver disease
KW - Liver fibrosis
KW - Parenteral nutrition
KW - Transient elastography
UR - http://www.scopus.com/inward/record.url?scp=85087417562&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.clnu.2020.05.039
DO - https://doi.org/10.1016/j.clnu.2020.05.039
M3 - Article
C2 - 32636112
SN - 0261-5614
VL - 40
SP - 460
EP - 466
JO - Clinical nutrition (Edinburgh, Scotland)
JF - Clinical nutrition (Edinburgh, Scotland)
IS - 2
ER -