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Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease

Laura Kalveram, Ulrich Baumann, Ruth De Bruyne (UGent) , Laura Draijer, Wojciech Janczyk, Deirdre Kelly, Bart G. Koot, Florence Lacaille, Sander Lefere (UGent) , Hadar Moran Lev, et al.
(2024) JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION. 78(1). p.27-35
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Abstract
Objectives: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of paediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of paediatric patients with NAFLD. Methods: The 457 patients with biopsy-proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F >= 1), moderate (F >= 2) or advanced (F >= 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB-4), paediatric NAFLD fibrosis score (PNFS) and paediatric NAFLD fibrosis index (PNFI). Results: Patients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB-4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB-4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT <= 50/ > 50 IU/L as a cut-off. Conclusions: Established fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk-stratification in paediatric NAFLD.
Keywords
fibrosis score, hepatic fibrosis, nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, noninvasive screening, POSITION PAPER, CHILDREN, BIOPSY, HEPATOLOGY, CIRRHOSIS, GASTROENTEROLOGY, STEATOHEPATITIS, GUIDELINE, DIAGNOSIS, SOCIETY

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MLA
Kalveram, Laura, et al. “Noninvasive Scores Are Poorly Predictive of Histological Fibrosis in Paediatric Fatty Liver Disease.” JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, vol. 78, no. 1, 2024, pp. 27–35, doi:10.1002/jpn3.12068.
APA
Kalveram, L., Baumann, U., De Bruyne, R., Draijer, L., Janczyk, W., Kelly, D., … Hudert, C. A. (2024). Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease. JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, 78(1), 27–35. https://doi.org/10.1002/jpn3.12068
Chicago author-date
Kalveram, Laura, Ulrich Baumann, Ruth De Bruyne, Laura Draijer, Wojciech Janczyk, Deirdre Kelly, Bart G. Koot, et al. 2024. “Noninvasive Scores Are Poorly Predictive of Histological Fibrosis in Paediatric Fatty Liver Disease.” JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION 78 (1): 27–35. https://doi.org/10.1002/jpn3.12068.
Chicago author-date (all authors)
Kalveram, Laura, Ulrich Baumann, Ruth De Bruyne, Laura Draijer, Wojciech Janczyk, Deirdre Kelly, Bart G. Koot, Florence Lacaille, Sander Lefere, Hadar Moran Lev, Judith Lubrecht, Jake P. Mann, Antonella Mosca, Sanjay Rajwal, Piotr Socha, Anita Vreugdenhil, Anna Alisi, and Christian A. Hudert. 2024. “Noninvasive Scores Are Poorly Predictive of Histological Fibrosis in Paediatric Fatty Liver Disease.” JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION 78 (1): 27–35. doi:10.1002/jpn3.12068.
Vancouver
1.
Kalveram L, Baumann U, De Bruyne R, Draijer L, Janczyk W, Kelly D, et al. Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease. JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION. 2024;78(1):27–35.
IEEE
[1]
L. Kalveram et al., “Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease,” JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION, vol. 78, no. 1, pp. 27–35, 2024.
@article{01HSXBZPVY5TX5PF7JTNVA2FD4,
  abstract     = {{Objectives: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of paediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of paediatric patients with NAFLD.

 Methods: The 457 patients with biopsy-proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F >= 1), moderate (F >= 2) or advanced (F >= 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB-4), paediatric NAFLD fibrosis score (PNFS) and paediatric NAFLD fibrosis index (PNFI).

 Results: Patients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB-4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB-4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT <= 50/ > 50 IU/L as a cut-off.

 Conclusions: Established fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk-stratification in paediatric NAFLD.}},
  author       = {{Kalveram, Laura and  Baumann, Ulrich and De Bruyne, Ruth and  Draijer, Laura and  Janczyk, Wojciech and  Kelly, Deirdre and  Koot, Bart G. and  Lacaille, Florence and Lefere, Sander and  Lev, Hadar Moran and  Lubrecht, Judith and  Mann, Jake P. and  Mosca, Antonella and  Rajwal, Sanjay and  Socha, Piotr and  Vreugdenhil, Anita and Alisi, Anna and Hudert, Christian A.}},
  issn         = {{0277-2116}},
  journal      = {{JOURNAL OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION}},
  keywords     = {{fibrosis score,hepatic fibrosis,nonalcoholic fatty liver disease,nonalcoholic steatohepatitis,noninvasive screening,POSITION PAPER,CHILDREN,BIOPSY,HEPATOLOGY,CIRRHOSIS,GASTROENTEROLOGY,STEATOHEPATITIS,GUIDELINE,DIAGNOSIS,SOCIETY}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{27--35}},
  title        = {{Noninvasive scores are poorly predictive of histological fibrosis in paediatric fatty liver disease}},
  url          = {{http://doi.org/10.1002/jpn3.12068}},
  volume       = {{78}},
  year         = {{2024}},
}
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