title: Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to fibrosis and cirrhosis. The paediatric NAFLD fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for fibrosis. To prospectively evaluate the performance of PNFI and TE in assessing clinically significant fibrosis in children with biopsy-proven NAFLD.
  
  
  METHODS
  Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis ≥ 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus.
  
  
  RESULTS
  Ten patients had fibrosis stage 2-3 and 57 patients had stage 0-1. Both PNFI and TE values were significantly higher in patients with significant fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant fibrosis in 98% of children with NAFLD.
  
  
  CONCLUSIONS
  In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA. alkhoun@ccf.org
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
authors.forename: Emad
authors.initials: E
authors.lastname: Sedki
authors.forename: Anna
authors.initials: A
authors.lastname: Alisi
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Massimo
authors.initials: M
authors.lastname: Pinzani
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Feldstein
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
mesh_terms: D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016009:Chi-Square Distribution; D002648:Child; D018450:Disease Progression; D004548:Elasticity; D054459:Elasticity Imaging Techniques; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D065626:Non-alcoholic Fatty Liver Disease; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D055105:Waist Circumference
chemical_list: D015415:Biomarkers; D014280:Triglycerides