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- Title
Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease.
- Authors
Kalveram, Laura; Baumann, Ulrich; De Bruyne, Ruth; Draijer, Laura; Janczyk, Wojciech; Kelly, Deirdre; Koot, Bart G.; Lacaille, Florence; Lefere, Sander; Lev, Hadar Moran; Lubrecht, Judith; Mann, Jake P.; Mosca, Antonella; Rajwal, Sanjay; Socha, Piotr; Vreugdenhil, Anita; Alisi, Anna; Hudert, Christian A.
- Abstract
Objectives: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of paediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of paediatric patients with NAFLD. Methods: The 457 patients with biopsy‐proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F ≥ 1), moderate (F ≥ 2) or advanced (F ≥ 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB‐4), paediatric NAFLD fibrosis score (PNFS) and paediatric NAFLD fibrosis index (PNFI). Results: Patients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB‐4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB‐4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT ≤ 50/ > 50 IU/L as a cut‐off. Conclusions: Established fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk‐stratification in paediatric NAFLD. What is Known: The high prevalence of nonalcoholic fatty liver disease (NAFLD) in children and its risk for the development of fibrosis and serious hepatic complications prompt the need for noninvasive monitoring tools.Noninvasive fibrosis scores are well validated in adult populations with NAFLD, while data on diagnostic utility in children and adolescents is limited. What is New: No fibrosis score accurately distinguished fibrosis from no fibrosis.For the detection of higher fibrosis stages, available fibrosis score systems show no advantage over the sole use of alanine aminotransferase (ALT).
- Publication
Journal of Pediatric Gastroenterology & Nutrition, 2024, Vol 78, Issue 1, p27
- ISSN
0277-2116
- Publication type
Article
- DOI
10.1002/jpn3.12068