Serum Ferritin and Liver Enzymes in Relation to 2D-Shear Wave Elastography-Determined Liver Fibrosis in Children with β-Thalassemia
Keywords:
Liver Enzymes, Serum Ferritin, Shear Wave Elastography, Liver Fibrosis, β-thalassemiaAbstract
Background and Aim: Iron overload resulting from chronic transfusion therapy is a major cause of liver injury in children with β-thalassemia. Serum ferritin and liver enzymes are commonly used to monitor iron burden and hepatic damage; however, their relationship with liver fibrosis assessed by two-dimensional shear wave elastography (2D-SWE) remains unclear. This study aims to evaluate the association between serum ferritin levels, liver enzymes, and the degree of liver fibrosis determined by 2D-SWE in pediatric patients with β-thalassemia.
Methods: A cross-sectional study was conducted at our institution, from December 2025 to March 2026. Thirty-three children with β-thalassemia who underwent liver 2D-SWE examination were included. All data were obtained from medical records. Descriptive statistics were used to summarize patient characteristics. Associations between categorical variables were analyzed using the Chi-square test, while comparisons of ferritin and liver enzyme levels across fibrosis stages were performed using the Mann–Whitney U test. A p-value <0.05 was considered statistically significant.
Results: Among the 33 participants, 57.6% were female and 51.5% were aged 5–10 years. The median serum ferritin level was 2,942 ng/mL, while the median AST and ALT levels were 48.5 U/L and 46.6 U/L, respectively. Based on 2D-SWE, 57.6% of patients were classified as F0–F1 and 42.4% as F2 fibrosis. No significant association was observed between fibrosis stage and serum ferritin level (p = 0.222). Similarly, AST (p = 0.560) and ALT (p = 0.174) levels were not significantly associated with fibrosis severity.
Conclusions: Serum ferritin, AST, and ALT levels were not significantly associated with the degree of liver fibrosis assessed by 2D-SWE in children with β-thalassemia. These findings suggest that laboratory biomarkers alone may not adequately reflect fibrosis severity and should be complemented by non-invasive imaging modalities such as 2D-SWE for liver fibrosis assessment.
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