https://pubmed.ncbi.nlm.nih.gov/34400208/ NAFLD

J Pediatr. 2021 Aug 13;S0022-3476(21)00768-X.

doi: 10.1016/j.jpeds.2021.08.012.Online ahead of print.
Relationship of Enhanced Liver Fibrosis Score with Pediatric Non-alcoholic Fatty Liver Disease Histology and Response to Vitamin E or Metformin

Samer Gawrieh 1, Kathryn E Harlow 2, Francis Pike 3, Katherine P Yates 4, Laura A Wilson 4, Oscar W Cummings 5, William M Rosenberg 6, Naga Chalasani 7, Jean P Molleston 2

Objectives: To study the diagnostic performance of the enhanced liver fibrosis score (ELF) for detecting different stages of fibrosis and its usefulness in detecting histological response to vitamin E or metformin in children with NAFLD who participated in the TONIC trial.

Study design: ELF was measured at baseline and weeks 24, 48, and 96 on sera from 166 TONIC participants. Associations between ELF with baseline and end of treatment (EOT) fibrosis stages and other histological features were assessed using chi-square tests and logistic regression models.

Results: ELF was significantly associated with severity of fibrosis at baseline and EOT. ELF areas under the curve for discriminating patients with clinically significant and advanced fibrosis were 0.70 (95% CI 0.60-0.80) and 0.79 (95% CI 0.69-0.89), respectively. A one unit drop in ELF at EOT was associated with overall histological improvement [OR 1.86 (1.11-3.14), P = .02], resolution of steatohepatitis [OR 1.88 (1.09-3.25), p= 0.02], improvement in steatosis grade [OR 1.76 (1.06- 2.82), p= 0.03] and hepatocellular ballooning [OR 1.79 (1.06-3.00), p= 0.03], but not with improvement in fibrosis stage [OR 1.26 (0.78-2.03), p=0.34].

Conclusions: ELF was associated with fibrosis stage in children who participated in TONIC. Although not associated with improvement in fibrosis, a drop in ELF at EOT was associated with NASH resolution and improvement in NAFLD histology. ELF may be a useful non-invasive test to monitor treatment response in children with NAFLD.