Development and validation of non-invasive models in predicting advanced fibrosis of choledochal cyst
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In brief
In brief
This study validates non-invasive blood-based indices (APRI, FIB-4) and introduces a novel AST-to-prealbumin ratio (APAR) for predicting advanced liver fibrosis in 330 pediatric choledochal cyst patients. Combined use of APAR and APRI improves identification of high-risk patients requiring urgent surgical intervention.
Written by the GCMD Library team from the article.
Abstract
Purpose
Patients with choledochal cyst (CDC) develop liver fibrosis, especially advanced fibrosis without prompt surgery. This study validated the aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and Fibrosis-4 index (FIB-4) and constructed a model for predicting advanced fibrosis in pediatric CDCs.
Methods
Between January 2020 and March 2022, 330 CDCs (advanced fibrosis: 34, Ludwig staging 3–4; non-advanced fibrosis: 296, Ludwig staging 0–2) were reviewed. APRI and FIB-4 were validated. The area under the receiver operating characteristic (AUROC) curve was used to assess discrimination. Relevant variables were analyzed by backward stepwise logistic regression. Enhanced bootstrap method was used for internal verification with 1000 samples.
Results
The AUROCs of APRI and FIB-4 were 0.761 (0.673–0.850) and 0.561 (0.455–0.667). AST to prealbumin ratio (APAR), was constructed with an AUROC of 0.776 (0.693–0.860). The AUROCs of APAR + APRI and APAR + FIB-4 were 0.791 (0.713–0.869) and 0.782 (0.699–0.865). No significant differences were noted in the AUROCs of the indices or their combinations. APAR and APRI could be used together to reduce missed diagnosis rate. The risk of advanced fibrosis varied from different APAR and APRI scores.
Conclusion
Both APAR and APRI were indispensable to identify CDC patients at high risk of advanced fibrosis.