title: A combination of the pediatric NAFLD fibrosis index and enhanced liver fibrosis test identifies children with fibrosis.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) encompasses diseases from simple steatosis, to steatohepatitis, to fibrosis, and cirrhosis. The pediatric NAFLD fibrosis index (PNFI) and the enhanced liver fibrosis (ELF) test are potential noninvasive markers for fibrosis. We prospectively evaluated the performance of PNFI and ELF in assessing fibrosis in children with biopsy-proven NAFLD.
  
  
  METHODS
  We analyzed 111 consecutive children with NAFLD. The stage of fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. PNFI was calculated based on age, waist circumference, and levels of triglycerides. The ELF test was used to determine levels of hyaluronic acid, the amino-terminal propeptide of type III collagen, and tissue inhibitor of metalloproteinase-1.
  
  
  RESULTS
  Some degree of fibrosis was detected in 68.5% of patients (62 had stage 1, 5 had stage 2, and 9 had stage 3). PNFI and ELF test values was higher among patients with fibrosis (P < .001). The area under the receiver operating characteristic (ROC) curve for predicting fibrosis using the PNFI and ELF test was 0.761 and 0.924, respectively. The best performance was obtained by combining PNFI and ELF test with (area under the receiver operating characteristic curve = 0.944). The combined results from the PNFI and ELF test predicted the presence or absence of fibrosis in 86.4% of children with NAFLD.
  
  
  CONCLUSIONS
  In children with NAFLD, the combined results from the PNFI and ELF test can accurately assess the presence of liver fibrosis and identify patients that should be evaluated by liver biopsy.
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, Ohio 44195, USA. alkhoun@ccf.org
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
authors.forename: Christine
authors.initials: C
authors.lastname: Carter-Kent
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: William M
authors.initials: WM
authors.lastname: Rosenberg
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinzani
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bedogni
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Feldstein
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
mesh_terms: D000367:Age Factors; D000465:Algorithms; D015415:Biomarkers / Q000032:analysis; D002648:Child; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000032:analysis; D008103:Liver Cirrhosis / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D008297:Male; D010446:Peptide Fragments / Q000032:analysis; D011347:Procollagen / Q000032:analysis; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019715:Tissue Inhibitor of Metalloproteinase-1 / Q000032:analysis; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; D011347:Procollagen; D019715:Tissue Inhibitor of Metalloproteinase-1; D014280:Triglycerides; C041876:procollagen Type III-N-terminal peptide; D006820:Hyaluronic Acid