https://pubmed.ncbi.nlm.nih.gov/39028885/ MASLD

Hepatology. 2024 Jul 19.
doi: 10.1097/HEP.0000000000001016. Online ahead of print.

Development and validation of pFIB scores for exclusion of significant liver fibrosis in pediatric MASLD

Sander Lefere 1 2, Antonella Mosca 3, Christian Hudert 4, Ellen Dupont 5, Emer Fitzpatrick 6 7, Eirini Kyrana 8, Anil Dhawan 6, Laura Kalveram 4, Andrea Pietrobattista 3, Anja Geerts 1 2, Ruth De Bruyne 9
Affiliations expand
PMID: 39028885

DOI: 10.1097/HEP.0000000000001016
Abstract

Background aims: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease, yet accurate risk scores for referral of children/adolescents with suspected clinically significant liver fibrosis are currently lacking.

Approach results: Clinical and biochemical variables were collected in a prospective cohort of 327 children and adolescents with severe obesity, in whom liver fibrosis was evaluated by transient elastography. Logistic regression was performed to establish continuous (pFIB-c) and simplified (pFIB-6) diagnostic scores that accurately exclude significant (≥F2) fibrosis. Performance for each was compared to established non-invasive fibrosis scores. These scores were validated in elastography (n=504) and multiple biopsy-proven MASLD (n=261) cohorts. Patient sex, ethnicity, weight z-score, HOMA-IR index, ALT, and presence of hypertension were included in the scores. The pFIB-c and pFIB-6 exhibited good discriminatory capacity (c-statistic of 0.839 and 0.826), outperforming existing indices. Negative predictive values (NPV) were >90% for both scores in the derivation and elastography validation cohorts. Performance in the histological cohorts varied (AUROCs for the pFIB-c between 0.710 and 0.770), as the scores were less accurate when applied to populations in tertiary referral centers characterized by a high prevalence of significant fibrosis and high ALT levels.

Conclusions: Analyzing several cohorts totaling approximately 1100 children and adolescents, we developed novel risk scores incorporating readily available clinical variables. In accordance with the aim of excluding pediatric MASLD-associated fibrosis, the scores performed better in non-selected cohorts of children and adolescents living with obesity than in patients referred to tertiary liver units.