Clinical value of transient elastography,aspartate aminotransferase-to-platelet ratio index,and fibrosis-4 in the diagnosis of liver fibrosis in children with biliary atresia

Objective To investigate the value of liver stiffness measurement( LSM) by transient elastography,aspartate aminotransferase-to-platelet ratio index( APRI),and fibrosis-4( FIB-4) in the diagnosis of liver fibrosis in children with biliary atresia. Methods A total of 110 children with biliary atresia who underwent Kasai operation in Department of Neonatal Surgery,Hunan Children's Hospital,from January 1,2016 to December 31,2018 were enrolled. Liver biopsy specimens and related clinical data were collected,including routine blood test results,liver function,and transient elastography results. The chi-square test was used for comparison of categorical data between groups. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data. MedCalc software was used to plot the receiver operating characteristic( ROC) curve,and the ROC curve was used to evaluate the diagnostic efficiency of LSM,APRI,and FIB-4 in evaluating the degree of liver fibrosis. The Spearman correlation analysis was also performed. Results The ROC curve analysis showed that in the diagnosis of biliary atresia with marked liver fibrosis( F≥2),LSM had an area under the ROC curve( AUC) of 0. 874( 95% confidence interval [CI]: 0. 778-0. 970) at the cut-off value of 9. 250 kPa,APRI had an AUC of 0. 636( 95% CI: 0. 362-0. 911) at the cut-off value of 0. 680,and FIB-4 had an AUC of 0. 622( 95% CI: 0. 363-0. 880) at the cut-off value of 0. 047; in the diagnosis of biliary atresia with progressive liver fibrosis( F≥3),LSM,APRI,and FIB-4 had an AUC of 0. 781( 95% CI: 0. 689-0. 873),0. 519( 95% CI: 0. 401-0. 636),and 0. 506( 95% CI: 0. 389-0. 623),respectively,at the cut-off value of 10. 75 k Pa,0. 70,and 0. 05,respectively; in the diagnosis of biliary atresia with liver cirrhosis( F≥4),LSM,APRI,and FIB-4 had an AUC of0. 855( 95% CI: 0. 769-0. 942),0. 701( 95% CI: 0. 599-0. 803),and 0. 717( 95% CI: 0. 609-0. 825),respectively,at the cut-off value of 11. 85 kPa,0. 82,and 0. 09,respectively. The correlation analysis showed that LSM was positively correlated with aspartate aminotransferase level( r = 0. 258,P = 0. 007) and was negatively correlated with platelet count( r =-0. 248,P = 0. 009). Conclusion Transient elastography has a high accuracy in determining the grade of liver fibrosis in children with biliary atresia,with a higher clinical value than APRI and FIB-4 in evaluating the degree of liver fibrosis.