Comparison of non-invasive liver fibrosis indicators for biliary atresia

To compare the value of non-invasive liver fibrosis indicators, including serum matrix metalloproteinase-7 (MMP-7), APRI, collagen-related proteins [hyaluronic acid (HA), type IV collagen (IV-C), type III procollagen N-terminal peptide (PIIIP), laminin] and shear wave elastography (SWE), in assessing liver fibrosis for biliary atresia (BA).

A retrospective cohort study was conducted in BA infants from July 2020 to December 2023. Liver fibrosis was classified according to the Batts-Ludwig criteria.

A total of 471 BA infants were included. Serum MMP-7, HA, IV-C, PIIIP, laminin, and SWE all correlated with liver fibrosis, with correlation coefficients of 0.4, 0.28, 0.37, -0.15, 0.16, and 0.46 (all P < 0.01), respectively. For severe fibrosis, the AUROC was 0.675 (95% CI: 0.622–0.728) at a cutoff value of 58.98 ng/ml for MMP-7, 0.719 (95% CI: 0.664-0.775) at a cutoff value of 547.05 for IV-C, and 0.732 (95% CI: 0.667–0.796) at a cutoff value of 1.35 m/s for SWE. Among the combined models, IV-C + MMP-7 achieved the higher performance (AUROC 0.756, 95% CI 0.700–0.811).

Non-invasive serum markers and SWE all showed moderate value for fibrosis assessment in BA. SWE may be a promising and useful non-invasive tool, while selected serum biomarker combinations may provide complementary value for identifying severe fibrosis.