Ischemia-Modified Albumin Levels in Children with Chronic Liver Disease

ABSTRACT

BACKGROUND/AIMS: Ischemia-modified albumin (IMA) levels have been shown to correlate with the severity of liver failure in adults. However, the role of IMA levels has not been evaluated in children with chronic liver disease (CLD). We analyzed the clinical significance of IMA levels in children with CLD. METHODS: Thirty-three children with CLD and 33 healthy children were included in the study. Blood was collected to analyze biochemical parameters, oxidant status, and IMA. Liver biopsies were re-evaluated for liver fibrosis; severe fibrosis (SF) was defined as fibrosis stage > or =4. RESULTS: The IMA and and IMA to albumin ratios (IMARs) were significantly higher in children with CLD than in those without (IMA 0.545+/-0.095 vs 0.481+/-0.062, p=0.003; IMAR 0.152+/-0.046 vs 0.126+/-0.018, p=0.04). The IMAR was positively correlated with the pediatric end-stage liver disease score (p=0.03, r=0.503) and fibrosis score (p=0.021, r=0.400). Patients with SF had higher IMARs compared to patients with mild fibrosis (0.181+/-0.056 vs 0.134+/-0.025, p=0.003). The area under the receiver operation curve (AUROC) for predicting SF was 0.78 (p=0.006). Using a cutoff ratio value of 0.140, the sensitivity and specificity were 84% and 70%, respectively. The AUROC for predicting the need for liver transplantation and/or death was 0.82 (p=0.013). With a cutoff value of 0.156, the sensitivity and specificity was 83% and 82%, respectively. Kaplan-Meier analysis revealed increased morbidity and/or mortality in the group with an IMAR>0.156 (50% vs 4.3%, p=0.005). CONCLUSIONS: IMARs have been shown to provide important clues in predicting the fibrosis stage of the disease and determining the outcome in children with CLD.