Naim Alkhouri, Sana Mansoor, Paola Giammaria, Rocio Lopez, Valerio Nobili,
Gastroenterology 2014 May; 146 (7): s 40
http://www.gastrojournal.org/article/S0016-5085%2814%2960040-8/pdf

Background:

Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. There is an urgent need to test and develop similar scores in children with NAFLD. The aim of our study was to assess the utility of commonly used adult fibrosis scores in pediatric NAFLD and to develop a pediatric specific fibrosis score that can predict advanced fibrosis.

Methods:
Consecutive children with biopsy-proven NAFLD were included. Fibrosis was determined by an experienced pathologist (F0-4). Advanced fibrosis was defined as fibrosis stage ≥ 3. The following adult fibrosis scores were calculated for each child: AST/ALT ratio, AST/ platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 Index. Multivariable
Logistic regression analysis was performed to build a new pediatric model for predicting advanced fibrosis. An automated stepwise variable selection method performed on 1000 bootstrap samples was used to choose the final model.

Results:
Our cohort consisted of 242 children with a mean age of 12.4 ± 3.1 years and 63% were female. 36 (15%) subjects had advanced fibrosis. Hypertension, higher triglycerides, ALT and AST, and GGT were significantly associated with presence of advanced fibrosis. APRI and FIB-4 were higher in patients with advanced fibrosis compared to those with fibrosis stage 0-2; however, AST/ ALT ratio and NFS were not different between the two groups. We used our data to develop a new model to predict advanced fibrosis which included the following variables: ALT, alkaline phosphatase, platelet counts and GGT. The multivariable logistic regression model (z) was defined as follows: z = 1.1 + (0.34*sqrt (ALT)) + (0.002*alkaline phosphatase) - (1.1*log (platelets) - (0.02*GGT). This value was then converted into a probability distribution (p) with a value between 0 to 100 by the following formula: p = 100 × exp (z)/ [1 + exp (z)]. The AUCROC for this model was 0.74 (95% CI: 0.66, 0.82). This was found to be significantly better than APRI, NAFLD Fibrosis Score and FIB-4 Index (Figure).

Conclusion:
Non-invasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric score, the PNFS, with improved performance characteristics. This score needs to be externally validated.

Published on: 
May-2014

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