Are there any non-invasive methods to predict liver fibrosis in children infected by hepatitis C virus rather than liver biopsy?
Pediatric Hepatology, Gastroenterology, and Nutrition Department, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Faculty of Medicine, King Salman International University, El Tor Branch, South Sinai, Egypt
Pathology Department, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Clinical Pathology, Laboratory Medicine Department, National Liver Institute, Menoufia University, Shebin El-Kom 32511, Egypt
Medical Physiology Department, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, EgyptMedical Physiology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Medical Biochemistry Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
Medical Biochemistry Department, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, Egypt
Histology and Cell Biology Department, Faculty of Medicine, Assiut University, Assiut, Egypt
Histology and Cell Biology Department, Faculty of Medicine, Suez University, 43221, Suez, Egypt
Pediatric Department, Faculty of Medicine, Al-Azhar University (Assiut), Assiut, Egypt
Fellow of Pediatrics at Shebin El-Kom Teaching Hospital, Shebin El-Kom 32511, Egypt
Fellow of Pediatrics and Neonatology at Damanhour Teaching Hospital, Damanhour, EgyptEpidemiology and Preventive Medicine Department, National Liver Institute, Menoufia University, Menoufia, Egypt
Pathology Department, Faculty of Medicine, Menoufia University, Shebin El-Kom 32511, Egypt
Clin Exp HEPATOL 2026; 12, 2: –0
Aim of the study
Since biopsy is an invasive procedure that is not suitable for routine monitoring, and hepatitis C virus (HCV) infection in children can lead to progressive liver damage, liver fibrosis, and its sequela, cirrhosis, aspartate aminotransferase (AST)-to-platelet ratio (APRI) and the fibrosis score (FIB-4) are increasingly substituting biopsy in the evaluation of liver fibrosis. APRI and FIB-4 are promising non-invasive markers for the safe and effective assessment of liver fibrosis. Thus, this study aimed to ascertain whether APRI and FIB-4 scores may be used to identify the stage of liver fibrosis among children diagnosed with HCV.
Material and methods
From July 2024 to August 2025, a total of 120 children diagnosed with HCV were enrolled in a retrospective study conducted at the Department of Pediatric Hepatology, Gastroenterology, and Nutrition, National Liver Institute, Menoufia University. The study population was divided into two groups: 22 patients were classified as the > F2 group, while 98 patients were assigned to the ≤ F2 group.
Results
There were no significant differences in hemoglobin (HB), white blood cells (WBCs), total bilirubin (TBIL), direct bilirubin (DBIL), alanine aminotransferase (ALT), AST, International Normalized Ratio (INR), and alanine aminotransferase/aspartate aminotransferase ratio (AAR) between the two groups under investigation. The ≤ F2 group showed significantly higher platelet (PLT), alkaline phosphatase (ALKP) and g-glutamyl trans ferase (GGT) in comparison to the > F2 group. More importantly, the > F2 group had considerably higher APRI, levels of serum albumin and FIB-4 than the ≤ F2 group.
Conclusions
In patients with persistent HCV infection, both the FIB-4 and APRI scores demonstrated high diagnostic accuracy in predicting the phases of liver fibrosis. The FIB-4 proved to be a useful non-invasive method for fibrosis assessment because of its exceptional performance, demonstrating high specificity, sensitivity, and overall accuracy.
Keywords
APRI, FIB-4, hepatitis C virus, liver fibrosis, liver biopsy, non-invasive markers, pediatrics
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