title: A non-invasive prediction model for non-alcoholic steatohepatitis in paediatric patients with non-alcoholic fatty liver disease.
abstract: BACKGROUND
  Non-alcoholic fatty liver disease encompasses a spectrum of diseases that range from simple steatosis to the aggressive form of non-alcoholic steatohepatitis. Non-alcoholic steatohepatitis is currently diagnosed through liver biopsy.
  
  
  OBJECTIVE
  To develop a non-invasive predictive model of non-alcoholic steatohepatitis in children with non-alcoholic fatty liver disease.
  
  
  METHODS
  Anthropometric, laboratory, and histologic data were obtained in a cohort of children with biopsy-proven non-alcoholic fatty liver disease. Multivariable logistic regression analysis was employed to create a nomogram predicting the risk of non-alcoholic steatohepatitis. Internal validation was performed by bootstrapping.
  
  
  RESULTS
  Three hundred and two children were included in this analysis with a mean age of 12.3 ± 3.1 years, a mean body mass index percentile of 94.3 ± 6.9, and non-alcoholic steatohepatitis was present in 67%. Following stepwise variable selection, total cholesterol, waist circumference percentile, and total bilirubin were included as variables in the model, with good discrimination with an area under the receiver operating characteristic curve of 0.737.
  
  
  CONCLUSIONS
  A nomogram was constructed with reasonable accuracy that can predict the risk of non-alcoholic steatohepatitis in children with non-alcoholic fatty liver disease. If validated externally, this tool could be utilized as a non-invasive method to diagnose non-alcoholic steatohepatitis in children with non-alcoholic fatty liver disease.
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH, United States.
authors.forename: Katharine
authors.initials: K
authors.lastname: Eng
authors.affiliation: Quantitative Health Sciences at the Cleveland Clinic Foundation, Cleveland, OH, United States.
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.affiliation: Liver Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Liccardo
authors.affiliation: Liver Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Nobili
authors.affiliation: Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, OH, United States; Digestive Disease Institute, Cleveland Clinic, Cleveland, OH, United States. Electronic address: alkhoun@ccf.org.
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
mesh_terms: D000293:Adolescent; D001707:Biopsy, Needle; D015992:Body Mass Index; D002648:Child; D015331:Cohort Studies; D005234:Fatty Liver / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007558:Italy; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D049451:Nomograms; D065626:Non-alcoholic Fatty Liver Disease / Q000175:diagnosis / Q000473:pathology* / Q000628:therapy*; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055105:Waist Circumference
keywords: Children; Nomogram; Non-alcoholic fatty liver disease; Non-alcoholic steatohepatitis