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ORIGINAL ARTICLE
Korean J Pediatr 2013 January;56(1) :19-25.
Published online 2013 January 15.        doi:https://doi.org/10.3345/kjp.2013.56.1.19
The efficacy of aspartate aminotransferase-toplatelet ratio index for assessing hepatic fibrosis in childhood nonalcoholic steatohepatitis for medical practice
Earl Kim (Kim E)1,2, Yunkoo Kang (Kang YK)1,2,*, Seungmin Hahn (Hahn SM)1,2,*, Mi Jung Lee (Lee MJ)2,3, Young Nyun Park (Park YN)4, Hong Koh (Koh H)1,2
1,2Department of Pediatrics, Yonsei University College of Medicine, Seoul
1,2,*Severance Pediatric Liver Disease Group, Severance Children's Hospital, Seoul, Severance Pediatric Liver Disease Group, Severance Children's Hospital, Seoul
2,3Severance Pediatric Liver Disease Group, Severance Children's Hospital, Seoul, Department of Diagnostic Radiology, Research Institute of Radiologic Science, Yonsei University College of Medicine, Seoul
4Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
Corresponding Author: Hong Koh ,Tel: +82-2-2228-2053, Fax: +82-2-393-9118, Email: khong@yuhs.ac
Copyright © 2013 by The Korean Pediatric Society
ABSTRACT
Purpose: Childhood obesity is associated with nonalcoholic fatty liver disease (NAFLD), and it has become one of the most common causes of childhood chronic liver diseases which significant as a cause of liver related mortality and morbidity in children in the United States. The development of simpler and easier clinical indices for medical practice is needed to identify advanced hepatic fibrosis in childhood NAFLD instead of invasive method like liver biopsy. FibroScan and aspartate aminotransferase (AST)-to-platelet ratio index (APRI) have been proposed as a simple and noninvasive predictor to evaluate hepatic fibrosis in several liver diseases. APRI could be a good alternative to detect pathologic change in childhood NAFLD. The purpose of this study is to validate the efficacy of APRI for assessing hepatic fibrosis in childhood NAFLD based on FibroScan.
Methods: This study included 23 children with NAFLD who underwent FibroScan. Clinical, laboratory and radiological evaluation including APRI was performed. To confirm the result of this study, 6 patients received liver biopsy.
Results: Factors associated with hepatic fibrosis (stiffness measurement >5.9 kPa Fibroscan) were triglyceride, AST, alanine aminotransferase, platelet count, APRI and collagen IV. In multivariate analysis, APRI were correlated with hepatic fibrosis (>5.9 kPa). In receiver operating characteristics curve, APRI of meaningful fibrosis (cutoff value, 0.4669; area under the receiver operating characteristics, 0.875) presented sensitivity of 94%, specificity of 66%, positive predictive value of 94%, and negative predictive value of 64%.
Conclusion: APRI might be a noninvasive, simple, and readily available method for medical practice to predict hepatic fibrosis of childhood NAFLD.
Keywords: Nonalcoholic fatty liver disease | Hepatic fibrosis | APRI | Child
 
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