title: The evaluation of hepatic fibrosis scores in children with nonalcoholic fatty liver disease.
abstract: BACKGROUND
  Nonalcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in children and can progress to liver cirrhosis during childhood. Patients with more advanced fibrosis on biopsy tend to have more liver complications. Noninvasive hepatic fibrosis scores have been developed for adult patients with NAFLD; however, these scores have not been validated in children. The aim of our study was to evaluate some of these scores in assessing the presence of fibrosis in children with biopsy-proven NAFLD.
  
  
  METHODS
  Our study consisted of 92 biopsy-proven NAFLD children from five major US centers. Fibrosis was determined by an experienced pathologist (F0-4). Clinically significant fibrosis was defined as fibrosis stage ≥ 2, and advanced fibrosis was defined as F3-4. The following fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 index. ROC was performed to assess the performance of different scores for prediction of presence of any, significant, or advanced fibrosis. A p value < 0.05 was considered statistically significant.
  
  
  RESULTS
  Mean age was 13.3 ± 3 years, and 33 % were females. Eleven (12 %) subjects had no fibrosis, 35 (38 %) had fibrosis score of 1, 26 (28 %) had fibrosis score of 2, and 20 (22 %) had a score of 3. APRI had a fair diagnostic accuracy for the presence of any fibrosis (AUC of 0.80) and poor diagnostic accuracy for significant or advanced fibrosis. AST/ALT, NFS, and FIB-4 index all either had poor diagnostic accuracy or failed to diagnose the presence of any, significant, or advanced fibrosis.
  
  
  CONCLUSIONS
  Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing significant fibrosis in children with NAFLD. Our results highlight the urgent need to develop a reliable pediatric fibrosis score.
authors.affiliation: Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH, 44195, USA.
authors.forename: Sana
authors.initials: S
authors.lastname: Mansoor
authors.forename: Lisa
authors.initials: L
authors.lastname: Yerian
authors.forename: Rohit
authors.initials: R
authors.lastname: Kohli
authors.forename: Stavra
authors.initials: S
authors.lastname: Xanthakos
authors.forename: Paul
authors.initials: P
authors.lastname: Angulo
authors.forename: Simon
authors.initials: S
authors.lastname: Ling
authors.forename: Rocio
authors.initials: R
authors.lastname: Lopez
authors.forename: Carter-Kent
authors.initials: CK
authors.lastname: Christine
authors.forename: Ariel E
authors.initials: AE
authors.lastname: Feldstein
authors.forename: Naim
authors.initials: N
authors.lastname: Alkhouri
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002648:Child; D004796:Clinical Enzyme Tests; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D008297:Male; D065626:Non-alcoholic Fatty Liver Disease / Q000097:blood / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D010976:Platelet Count; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014481:United States
chemical_list: D015415:Biomarkers; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase