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Utility and accuracy of transient elastography in determining liver fibrosis: a case-control study

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A Correction to this article was published on 26 February 2020

This article has been updated

Abstract

The objectives of this prospective case-control study were to determine liver stiffness (LSM) by transient elastography (TE) in children with newly diagnosed chronic liver disease (CLD) and to find out normal values in healthy Indian children. Two groups (A: 50 CLD who underwent liver biopsy and B: 50 healthy) aged 5–18 years were recruited prospectively. Liver biopsies were scored as per Metavir scoring and compared with TE. The median age of 100 recruited children was 13.6 years. In group B, normal LSM was 4.9 (2.5–7.3) kPa with significantly higher LSM in adolescent males (5.6 (4.1–7.3) kPa) as compared with females (4.3 (3.7–4.9) kPa), p = 0.001. In group A, TE was excellent in discriminating significant fibrosis (≥ F2) (P = 0.001) at a cut-off value of 10.6 kPa with area under receiver operating characteristic curve of 0.96. Metavir fibrosis stage (β = 0.611; R2 = 0.586) and age (β = 0.230; R2 = 0.586) were independent variables associated with higher LSM in stepwise multiple logistic regression analysis.

Conclusions: TE is an excellent non-invasive tool to assess significant liver fibrosis and can be used as an alternative to liver biopsy. Normative value of TE in adolescent males is higher than in females.

What is Known:

• Transient elastography is a good non-invasive test for liver fibrosis assessment.

• Normal liver stiffness depends on race, gender, and age.

What is New:

• This is the first study from India to show the normative data of transient elastography in healthy Indian children.

• We have documented that liver stiffness measurement by fibroscan in treatment naïve chronic liver disease has excellent correlation in significant fibrosis, severe fibrosis, and cirrhosis.

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Change history

  • 26 February 2020

    The author regrets that one of the author’s name was incorrectly presented in the published version of this article. The third author’s name original read as “<Emphasis Type="Bold">Tajwar Singh Negi</Emphasis>” this should have been “<Emphasis Type="Bold">Tajwer Singh Negi</Emphasis>”.

Abbreviations

AUROC:

Area under the receiver operating characteristic

ANA:

Anti-nuclear antibody

Anti HBe:

Antibody to hepatitis B e-antigen

BMI:

Body mass index

CLD:

Chronic liver disease

CTP:

Child–Turcotte–Pugh

EGD:

Esophagogastroduodenoscopy

HBsAg:

Hepatitis B surface antigen

HBeAg:

Hepatitis B e-antigen

HBV-DNA:

Hepatitis B deoxyribonucleic acid

HCV RNA:

Hepatitis C ribonucleic acid

IQR:

Interquartile range

LSM:

Liver stiffness measurement

LKM:

Liver kidney microsomal antibody

MELD:

Model for end-stage liver disease

NAFLD:

Non-alcoholic fatty liver disease

PELD:

Pediatric end-stage liver disease

ROC:

Receiver operating characteristic

SMA:

Anti-smooth muscle antibody

TE:

Transient elastography

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Author information

Authors and Affiliations

  1. Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226014, India

    Vikas Jain, Ujjal Poddar, Surender Kumar Yachha & Anshu Srivastava

  2. Department of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Tajwar Singh Negi & Vivek A Saraswat

  3. Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India

    Narendra Krishnani

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  1. Vikas Jain
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  2. Ujjal Poddar
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  3. Tajwar Singh Negi
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  4. Vivek A Saraswat
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  7. Anshu Srivastava
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Vikas Jain, Ujjal Poddar, Negi TS, Vivek A Saraswat, Narendra Krishnani, Surender K Yachha, and Anshu Srivastav. The first draft of the manuscript was written by Vikas Jain and Ujjal Poddar. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ujjal Poddar.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors. The study was conducted after obtaining clearance from the Institutional Ethics Committee (IEC code: 2014-83-DM-77). Informed written consent was obtained from either parent before doing all invasive procedures and TE. Informed consent: Informed written consent was obtained from either parent before doing all invasive procedures and transient elastography.

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Communicated by Peter de Winter

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The original version of this article was revised: The author regrets that one of the author’s name was incorrectly presented in the published version of this article. The third author’s name original read as “Tajwer Singh Negi”, this should have been “Tajwar Singh Negi”.

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Jain, V., Poddar, U., Negi, T.S. et al. Utility and accuracy of transient elastography in determining liver fibrosis: a case-control study. Eur J Pediatr 179, 671–677 (2020). https://doi.org/10.1007/s00431-019-03561-y

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  • DOI: https://doi.org/10.1007/s00431-019-03561-y

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