Metabolic dysfunction-associated steatotic liver disease in children – A growing problem with a need for non-invasive diagnostic tools
Wang A et al, Hepatology. 2024;79(6):1381–92
The importance of non-invasive scores for estimating the extent of chronic liver disease is particularly important in pediatric medicine. This study presents such a score, which is certainly difficult to calculate due to its complexity with a total of 14 variables (laboratory parameters, as well as age, gender, height and weight), but as a tool for the risk stratification of a potentially relevant liver fibrosis for a growing number of children, it might prove valuable.
Background and aims: Liver fibrosis is common in children with non-alcoholic fatty liver disease (NAFLD) and is an important determinant of outcomes. High-performing non-invasive models to assess fibrosis in children are needed. The objectives of this study were to evaluate the performance of existing pediatric and adult fibrosis prediction models and to develop a clinical prediction rule for identifying moderate-to-severe fibrosis in children with NAFLD.
Approach and results: The authors enrolled children with biopsy-proven NAFLD in the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) within 90 days of liver biopsy, and staged liver fibrosis in consensus using the NASH CRN scoring system. They evaluated existing pediatric and adult models for fibrosis and developed a new pediatric model using the least absolute shrinkage and selection operator with linear and spline terms for discriminating moderate-to-severe fibrosis from none or mild fibrosis. The model was internally validated with 10-fold cross-validation. 1055 children were evaluated with NAFLD, of whom 26% had moderate-to-severe fibrosis. Existing models performed poorly in classifying fibrosis in children, with area under the receive roperating curves (AUCs) ranging from 0.57 to 0.64. In contrast, the new model, fibrosis in pediatric NAFLD was derived from 14 common clinical variables and had an AUC of 0.79 (95% confidence interval: 0.77–0.81) with 72% sensitivity and 76% specificity for identifying moderate-to-severe fibrosis.
Conclusions: Existing fibrosis prediction models have limited clinical utility in children with non-alcoholic fatty liver disease (NAFLD). Fibrosis in pediatric NAFLD offers improved performance characteristics for risk stratification by identifying moderate-to-severe fibrosis in children with NAFLD.