Clinical Value of Non-Invasive Indicators in Predicting Advanced Liver Fibrosis in Children with Autoimmune Hepatitis

Biopsy is the standard criterion for the diagnosis of liver fibrosis, but it is not widely used for liver fibrosis monitoring due to its invasive nature, risk of complications, and sampling errors. This study aimed to evaluate the clinical significance of several noninvasive indices in diagnosis of the disease and in prediction of advanced liver fibrosis in children with autoimmune hepatitis (AIH).

In a prospective cross-sectional study, in 40 children with AIH, complete blood count and liver function tests were performed and their derived indices were calculated. Based on liver biopsy, all patients with AIH were divided into two groups: absent/mild fibrosis and moderate/severe fibrosis (advanced fibrosis).

In patients with AIH, aspartate aminotransferase to platelet ratio index (APRI) and fibrosis index based on four factors (FIB-4) increased significantly (P<0.001) and neutrophil to lymphocyte ratio index (NLR) decreased significantly (P=0.041) compared to healthy individuals. In patients with advanced fibrosis, direct bilirubin (DBIL) and APRI levels were considerably higher and albumin levels were considerably lower compared to the absent/mild fibrosis group. Analysis of the area under the receiver operating characteristic curve (AUC) showed that FIB-4 and APRI have clinical value for the diagnosis of AIH in children while DBIL and APRI had clinical value in diagnosis of advanced liver fibrosis in these children.

APRI can be used as a reference index in diagnosis of AIH in children and to monitor liver fibrosis in children with autoimmune hepatitis.