Utility of APRI to Predict Liver Fibrosis in Intestinal Failure Associated Liver Disease in Pediatric Patients

CAROLINA RUMBO; MARÍA I. MARTÍNEZ; ANA CABANNE; JULIO TRENTADUE; ADRIANA FERNANDEZ; GABRIEL E. GONDOLESI

Simposio; International Small Bowel Transplant Symposium 2015; 2015

Intestinal Transplant Association

Background: intestinal failure associated liver disease (IFALD) is afrequent indication for isolated or combined intestinal transplantation.It is influenced by multiple factors and its progression rate is so farumpredictable. Liver biopsy (Lbx) is the gold standard diagnosis.Identifying surveillance non invasive markers to determine fibrosisprogression in this population would indicate the best timing to performa Lbx and to evaluate the patients for intestinal transplant. Aspartateaminotransferase/platelet ratio index (APRI) has a goodcorrelation in adult patients with chronic liver disease; few studieshave been performed in children with IFALD.Aim: To evaluate/validate the use of APRI, in a cohort of childrenwith IFALD.Material y Methods: Retrospective analysis of a prospective databaseof pts < 18 years with severe IF and at least one Lbx, registeredin our unit from 3/2006 to 12/2014. Variables include: age at Lbx,time of intestinal failure prior to Lbx, presence of cholestasis (directbilirubin >2 mg/dl), Lbx indication, cause of intestinal failure, fibrosisgrade (METAVIR score), APRI score. Statistical analysis was performedusing SPSS.Results: Forty-nine Lbx were done on 36 pts, 20 were male, 31 ptshad short gut. Eleven pts had more than one Lbx. Mean age 4 years(r= 3 months- 13 years). Mean time on PN was 30 months (r= 3 to147 months). 13/36 pts had cholestasis (mean direct bilirubin 5,9mg/dl at Lbx time) and received 18 LBx (1.4LBx/pt); 31 Lbx were indicatedin 24 pts (1.3 LBx/pt, p:NS) due to indirect signs or symptomsof IFALD with no cholestasis. Thirty three Lbx had METAVIR ≤ 2(Group 1), 7 in pts with cholestasis; and 16 had METAVIR ≥ 3 (Group2), 11 in pts with cholestasis (p:0.004)- Median APRI was: 0.92 ±1.04 IR for G1, and 2.5 ± 4.68 IR for G2 (p=0.03). The ROC curve(figure 1) shows: 0.79± 0.075 SE; 95% CI: 0.65 to 0.89; Sensitivity:81,3, Specificity: 75%; cut off value > 1.5 (figure 2); PPV:59%; NPV:89%.Conclusions: The APRI score was evaluated and validated in ourcohort of pediatric patients with IFALD showing that a score > 1.5 correlateswith advanced fibrosis, indicating the need of a liver biopsy.References:1. J Ped Gastroent. And Nutrition 2013;sept 57(3):3762. J. Ped Surg 2010;Jun 45/6:12663. BMC gastroenterology 2011;11:91