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http://dx.doi.org/10.3345/kjp.2013.56.1.19

The efficacy of aspartate aminotransferase-to-platelet ratio index for assessing hepatic fibrosis in childhood nonalcoholic steatohepatitis for medical practice  

Kim, Earl (Department of Pediatrics, Yonsei University College of Medicine)
Kang, Yunkoo (Department of Pediatrics, Yonsei University College of Medicine)
Hahn, Seungmin (Department of Pediatrics, Yonsei University College of Medicine)
Lee, Mi Jung (Severance Pediatric Liver Disease Group, Severance Children's Hospital)
Park, Young Nyun (Department of Pathology, Yonsei University College of Medicine)
Koh, Hong (Department of Pediatrics, Yonsei University College of Medicine)
Publication Information
Clinical and Experimental Pediatrics / v.56, no.1, 2013 , pp. 19-25 More about this Journal
Abstract
Purpose: Childhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan. Methods: This study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy. Results: Factors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%. Conclusion: APRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD.
Keywords
Nonalcoholic fatty liver disease; Hepatic fibrosis; APRI; Child;
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1 Afdhal NH, Nunes D. Evaluation of liver fibrosis: a concise review. Am J Gastroenterol 2004;99:1160-74.   DOI   ScienceOn
2 Poynard T, Imbert-Bismut F, Munteanu M, Messous D, Myers RP, Thabut D, et al. Overview of the diagnostic value of biochemical markers of liver fibrosis (FibroTest, HCV FibroSure) and necrosis (ActiTest) in patients with chronic hepatitis C. Comp Hepatol 2004;3:8.   DOI   ScienceOn
3 Shaheen AA, Wan AF, Myers RP. FibroTest and FibroScan for the prediction of hepatitis C-related fibrosis: a systematic review of diagnostic test accuracy. Am J Gastroenterol 2007;102:2589-600.   DOI   ScienceOn
4 Zhou K, Gao CF, Zhao YP, Liu HL, Zheng RD, Xian JC, et al. Simpler score of routine laboratory tests predicts liver fibrosis in patients with chronic hepatitis B. J Gastroenterol Hepatol 2010;25:1569-77.   DOI   ScienceOn
5 Leroy V, Hilleret MN, Sturm N, Trocme C, Renversez JC, Faure P, et al. Prospective comparison of six non-invasive scores for the diagnosis of liver fibrosis in chronic hepatitis C. J Hepatol 2007;46:775-82.   DOI   ScienceOn
6 Shin WG, Park SH, Jang MK, Hahn TH, Kim JB, Lee MS, et al. Aspartate aminotransferase to platelet ratio index (APRI) can predict liver fibrosis in chronic hepatitis B. Dig Liver Dis 2008; 40:267-74.   DOI   ScienceOn
7 Borsoi Viana MS, Takei K, Collarile Yamaguti DC, Guz B, Strauss E. Use of AST platelet ratio index (APRI Score) as an alternative to liver biopsy for treatment indication in chronic hepatitis C. Ann Hepatol 2009;8:26-31.
8 Wai CT, Greenson JK, Fontana RJ, Kalbfleisch JD, Marrero JA, Conjeevaram HS, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology 2003;38:518-26.
9 Wai CT, Cheng CL, Wee A, Dan YY, Chan E, Chua W, et al. Noninvasive models for predicting histology in patients with chronic hepatitis B. Liver Int 2006;26:666-72.   DOI   ScienceOn
10 Lebensztejn DM, Skiba E, Sobaniec-Lotowska M, Kaczmarski M. A simple noninvasive index (APRI) predicts advanced liver fibrosis in children with chronic hepatitis B. Hepatology 2005;41:1434-5.   DOI   ScienceOn
11 Lackner C, Struber G, Liegl B, Leibl S, Ofner P, Bankuti C, et al. Comparison and validation of simple noninvasive tests for prediction of fibrosis in chronic hepatitis C. Hepatology 2005;41:1376-82.   DOI   ScienceOn
12 Sim SJ, Cheong JY, Cho SW, Kim JS, Lim TY, Shin DH, et al. Efficacy of AST to platelet ratio index in predicting severe hepatic fibrosis and cirrhosis in chronic hepatitis B virus infection. Korean J Gastroenterol 2005;45:340-7.
13 Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cardenas E, Sanchez-Avila F, Vargas-Vorackova F. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol 2008;7:350-7.
14 Chang HK, Park YJ, Koh H, Kim SM, Chung KS, Oh JT, et al. Hepatic fibrosis scan for liver stiffness score measurement: a useful preendoscopic screening test for the detection of varices in postoperative patients with biliary atresia. J Pediatr Gastroenterol Nutr 2009;49:323-8.   DOI   ScienceOn
15 Lin CS, Chang CS, Yang SS, Yeh HZ, Lin CW. Retrospective evaluation of serum markers APRI and AST/ALT for assessing liver fibrosis and cirrhosis in chronic hepatitis B and C patients with hepatocellular carcinoma. Intern Med 2008;47:569-75.   DOI
16 Fujii H, Enomoto M, Fukushima W, Ohfuji S, Mori M, Kobayashi S, et al. Noninvasive laboratory tests proposed for predicting cirrhosis in patients with chronic hepatitis C are also useful in patients with non-alcoholic steatohepatitis. J Gastroenterol 2009;44:608-14.   DOI
17 Palmeri ML, Wang MH, Rouze NC, Abdelmalek MF, Guy CD, Moser B, et al. Noninvasive evaluation of hepatic fibrosis using acoustic radiation force-based shear stiffness in patients with nonalcoholic fatty liver disease. J Hepatol 2011;55:666-72.   DOI   ScienceOn
18 Castera L, Forns X, Alberti A. Non-invasive evaluation of liver fibrosis using transient elastography. J Hepatol 2008;48:835-47.   DOI   ScienceOn
19 Castera L, Vergniol J, Foucher J, Le Bail B, Chanteloup E, Haaser M, et al. Prospective comparison of transient elastography, Fibrotest, APRI, and liver biopsy for the assessment of fibrosis in chronic hepatitis C. Gastroenterology 2005;128:343-50.   DOI   ScienceOn
20 Vizzutti F, Arena U, Romanelli RG, Rega L, Foschi M, Colagrande S, et al. Liver stiffness measurement predicts severe portal hypertension in patients with HCV-related cirrhosis. Hepatology 2007;45:1290-7.   DOI   ScienceOn
21 Myers RP, Ratziu V, Imbert-Bismut F, Charlotte F, Poynard T; MULTIVIRC Group. Groupe d'Etude Multidisciplinaire sur les Pathologies Liées au Virus C. Biochemical markers of liver fibrosis: a comparison with historical features in patients with chronic hepatitis C. Am J Gastroenterol 2002;97:2419-25.   DOI   ScienceOn
22 Nguyen-Khac E, Chatelain D, Tramier B, Decrombecque C, Robert B, Joly JP, et al. Assessment of asymptomatic liver fibrosis in alcoholic patients using fibroscan: prospective comparison with seven non-invasive laboratory tests. Aliment Pharmacol Ther 2008;28:1188-98.   DOI   ScienceOn
23 Kim SY, Seok JY, Han SJ, Koh H. Assessment of liver fibrosis and cirrhosis by aspartate aminotransferase-to-platelet ratio index in children with biliary atresia. J Pediatr Gastroenterol Nutr 2010;51:198-202.   DOI   ScienceOn
24 Kaneda H, Hashimoto E, Yatsuji S, Tokushige K, Shiratori K. Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease. J Gastroenterol Hepatol 2006;21:1459-65.
25 Imbert-Bismut F, Ratziu V, Pieroni L, Charlotte F, Benhamou Y, Poynard T, et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001; 357:1069-75.   DOI   ScienceOn
26 Barshop NJ, Francis CS, Schwimmer JB, Lavine JE. Nonalcoholic fatty liver disease as a comorbidity of childhood obesity. Ped Health 2009;3:271-81.   DOI   ScienceOn
27 Fierbinteanu-Braticevici C, Dina I, Petrisor A, Tribus L, Negreanu L, Carstoiu C. Noninvasive investigations for non alcoholic fatty liver disease and liver fibrosis. World J Gastroenterol 2010;16:4784-91.   DOI   ScienceOn
28 Nobili V, Alisi A, Vania A, Tiribelli C, Pietrobattista A, Bedogni G. The pediatric NAFLD fibrosis index: a predictor of liver fibrosis in children with non-alcoholic fatty liver disease. BMC Med 2009;7:21.   DOI   ScienceOn
29 Nobili V, Reale A, Alisi A, Morino G, Trenta I, Pisani M, et al. Elevated serum ALT in children presenting to the emergency unit: relationship with NAFLD. Dig Liver Dis 2009;41:749-52.   DOI   ScienceOn
30 McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut 2010;59:1265-9.   DOI   ScienceOn
31 de Ledinghen V, Le Bail B, Rebouissoux L, Fournier C, Foucher J, Miette V, et al. Liver stiffness measurement in children using FibroScan: feasibility study and comparison with Fibrotest, aspartate transaminase to platelets ratio index, and liver biopsy. J Pediatr Gastroenterol Nutr 2007;45:443-50.   DOI   ScienceOn
32 Yoneda M, Yoneda M, Mawatari H, Fujita K, Endo H, Iida H, et al. Noninvasive assessment of liver fibrosis by measurement of stiffness in patients with nonalcoholic fatty liver disease (NAFLD). Dig Liver Dis 2008;40:371-8.   DOI   ScienceOn