Performance of fibrosis prediction scores in paediatric non-alcoholic fatty liver disease

Abstract

Aim: Non-alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. The phenotype of NAFLD varies widely, and non-invasive predictors of disease severity are scarce and are needed to tailor clinical management.

Methods: We compared liver fibrosis by histology with proposed non-invasive predictors of fibrosis, including alanine transaminase (ALT), aspartate transaminase (AST), AST/ALT ratio, AST to platelet ratio index, fibrosis-4, paediatric NAFLD fibrosis index and paediatric NAFLD fibrosis score.

Results: The area under the curve of scores obtained while predicting fibrosis in children with NAFLD ranged from 0.51 to 0.67.

Conclusion: The tested non-invasive fibrosis scoring systems, some of which were originally designed for adult populations, did not adequately predict fibrosis in a paediatric cohort. Further development of risk prediction scores in children are needed for the management of paediatric patients and will likely need to be developed within a large paediatric data set in order to improve specificity and sensitivity.

Keywords: children; fibrosis scoring system; liver enzymes; non-alcoholic fatty liver disease; non-invasive marker of hepatic fibrosis.