Use of a combined transient elastography and biochemical strategy to determine liver fibrosis in pediatric intestinal failure

Koen Huysentruyt; Christina Belza; Sylvia Wong-Sterling; Rose Chami; Iram Siddiqui; Paul W Wales; Yaron Avitzur

doi:10.1016/j.clnu.2022.12.002

Use of a combined transient elastography and biochemical strategy to determine liver fibrosis in pediatric intestinal failure

Clin Nutr. 2023 Feb;42(2):136-142. doi: 10.1016/j.clnu.2022.12.002. Epub 2022 Dec 9.

Authors

Koen Huysentruyt¹, Christina Belza², Sylvia Wong-Sterling², Rose Chami³, Iram Siddiqui³, Paul W Wales⁴, Yaron Avitzur⁵

Affiliations

¹ The Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Brussels Centrum for Intestinal Failure in Children (B-CIRC), Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
² The Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
³ Division of Pathology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
⁴ The Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, United States.
⁵ The Group for Improvement of Intestinal Function and Treatment (GIFT), Transplant and Regenerative Medicine Centre, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. Electronic address: yaron.avitzur@sickkids.ca.

PMID: 36563562
DOI: 10.1016/j.clnu.2022.12.002

Abstract

Background & aims: Non-invasive monitoring of intestinal failure (IF) associated liver disease is an ongoing challenge in children with IF. Our objective was to develop a combined algorithm of clinical, transient elastography (TE) and biochemical parameters to identify liver fibrosis in this population.

Methods: A retrospective cohort study of IF patients followed by our intestinal rehabilitation program between November 2015 to October 2019. Patients with a liver biopsy and TE were included. Demographic and liver function tests were collected. Fibrosis on liver biopsies was graded using the modified Scheuer score. Decision tree based algorithms classified low (F0-F1) versus high (F2-F4) fibrosis scores based on a combination of TE, biochemical and demographic parameters, using 6-fold classification error, sensitivity and specificity cross-validation (CV) scores.

Results: 42 patients (74% male, median age 7.6 (4.6; 42.7) months) were evaluated. Median length of PN therapy was 182 (121; 556) days. High fibrosis was present in 40.5% with a median TE of 12.1 (6.7; 12.9) kPa in high fibrosis children. An algorithm, based on cut-off values for TE of 11.3 kPa and AST of 40 U/L, and grouping of the underlying etiology resulted in a correct classification of 88.1% of the pathology scores; with sensitivity 0.82 (95% CI 0.57; 0.96), specificity 0.92 (95% CI 0.74; 0.99), positive predictive value 0.88 (95% CI 0.64; 0.96) and negative predictive value 0.88 (95% CI 0.73; 0.96). The CV classification error was 28.6%, CV sensitivity 72.2% and CV specificity 75.5%.

Conclusions: This algorithm shows promising results that could simplify non-invasive monitoring of liver fibrosis in children with IF. Validation in additional IF cohorts is needed.

Keywords: Children; Decision tree algorithm; Elastography; Fibroscan; Fibrosis; Intestinal failure; Intestinal failure associated liver disease (IFALD).

MeSH terms

Child
Elasticity Imaging Techniques* / methods
Humans
Intestinal Failure*
Liver / diagnostic imaging
Liver / pathology
Liver Cirrhosis / diagnosis
Liver Cirrhosis / diagnostic imaging
Retrospective Studies