Darrick K Li1, Muhammad Rehan Khan2, Zhen Wang3, Voranush Chongsrisawat4, Panida Swangsak4, Ulrike Teufel-Schäfer5, Guido Engelmann6, Imeke Goldschmidt7, Ulrich Baumann7,8, Daisuke Tokuhara9, Yuki Cho9, Marion Rowland10, Anders B Mjelle11,12,13, Grant A Ramm14, Peter J Lewindon15, Peter Witters16, David Cassiman17, Ioana M Ciuca18, Larry D Prokop3, Samir Haffar19, Kathleen E Corey1, M H Murad3, Katryn N Furuya20, Fateh Bazerbachi1. 1. Division of Gastroenterology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 2. Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine at Peoria, Children's Hospital of Illinois, Peoria, IL, USA. 3. Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. 4. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. 5. Department of Pediatrics and Adolescent Medicine, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany. 6. Department of Pediatrics, Lukas Hospital, Neuss, Germany. 7. Division of Paediatric Gastroenterology and Hepatology, Hannover Medical School, Hannover, Germany. 8. Institute of Immunology and Immunotherapy, University of Birmingham, United Kingdom. 9. Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan. 10. School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. 11. Department of Pediatric and Adolescent Medicine, Haukeland University Hospital, Bergen, Norway. 12. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 13. National Centre for Ultrasound in Gastroenterology, Department of Medicine, Haukeland University Hospital, Bergen, Norway. 14. Hepatic Fibrosis Group, QIMR Berghofer Medical Research Institute, Herston, QLD, Australia. 15. Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia. 16. Department of Paediatrics, University Hospitals Leuven, Leuven, Belgium. 17. Department of Gastroenterology-Hepatology and Metabolic Center, University of Leuven, Leuven, Belgium. 18. Pediatrics Department, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania. 19. Digestive Center for Diagnosis and Treatment, Damascus, Syrian Arab Republic. 20. Department of Pediatrics, University of Wisconsin - Madison School of Medicine and Public Health, Madison, WI, USA.
Abstract
BACKGROUND & AIMS: Although transient elastography (TE) is used to determine liver stiffness as a surrogate to hepatic fibrosis, the normal range in children is not well defined. We performed a systematic review and individual participant data (IPD) meta-analysis to determine the range of liver stiffness in healthy children and evaluate the influence of important biological parameters. METHODS: We pooled data from 10 studies that examined healthy children using TE. We divided 1702 children into two groups: ≥3 years (older group) and < 3 years of age (younger group). Univariate and multivariate linear regression models predicting liver stiffness were conducted. RESULTS: After excluding children with obesity, diabetes, or abnormal liver tests, 652 children were analysed. Among older children, mean liver stiffness was 4.45 kPa (95% confidence interval 4.34-4.56), and increased liver stiffness was associated with age, sedation status, and S probe use. In the younger group, the mean liver stiffness was 4.79 kPa (95% confidence interval 4.46-5.12), and increased liver stiffness was associated with sedation status and Caucasian race. In a subgroup analysis, hepatic steatosis on ultrasound was significantly associated with increased liver stiffness. We define a reference range for normal liver stiffness in healthy children as 2.45-5.56 kPa. CONCLUSIONS: We have established TE-derived liver stiffness ranges for healthy children and propose an upper limit of liver stiffness in healthy children to be 5.56 kPa. We have identified increasing age, use of sedation, probe size, and presence of steatosis on ultrasound as factors that can significantly increase liver stiffness.
BACKGROUND & AIMS: Although transient elastography (TE) is used to determine liver stiffness as a surrogate to hepatic fibrosis, the normal range in children is not well defined. We performed a systematic review and individual participant data (IPD) meta-analysis to determine the range of liver stiffness in healthy children and evaluate the influence of important biological parameters. METHODS: We pooled data from 10 studies that examined healthy children using TE. We divided 1702 children into two groups: ≥3 years (older group) and < 3 years of age (younger group). Univariate and multivariate linear regression models predicting liver stiffness were conducted. RESULTS: After excluding children with obesity, diabetes, or abnormal liver tests, 652 children were analysed. Among older children, mean liver stiffness was 4.45 kPa (95% confidence interval 4.34-4.56), and increased liver stiffness was associated with age, sedation status, and S probe use. In the younger group, the mean liver stiffness was 4.79 kPa (95% confidence interval 4.46-5.12), and increased liver stiffness was associated with sedation status and Caucasian race. In a subgroup analysis, hepatic steatosis on ultrasound was significantly associated with increased liver stiffness. We define a reference range for normal liver stiffness in healthy children as 2.45-5.56 kPa. CONCLUSIONS: We have established TE-derived liver stiffness ranges for healthy children and propose an upper limit of liver stiffness in healthy children to be 5.56 kPa. We have identified increasing age, use of sedation, probe size, and presence of steatosis on ultrasound as factors that can significantly increase liver stiffness.
Authors: Pradeep K Siddappa; Fadi Hawa; Larry J Prokop; M Hassan Murad; Barham K Abu Dayyeh; Vinay Chandrasekhara; Mark D Topazian; Fateh Bazerbachi Journal: Gastroenterol Rep (Oxf) Date: 2021-02-03
Authors: Fateh Bazerbachi; Akira Dobashi; Swarup Kumar; Sanjay Misra; Navtej S Buttar; Louis M Wong Kee Song Journal: Gastroenterol Rep (Oxf) Date: 2020-12-03