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Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease

  1. Naim Alkhouri1,2,*,
  2. Emad Sedki3,
  3. Anna Alisi5,
  4. Rocio Lopez4,
  5. Massimo Pinzani6,
  6. Ariel E. Feldstein7,
  7. Valerio Nobili5

Article first published online: 12 NOV 2012

DOI: 10.1111/liv.12024

Issue

Liver International

Liver International

Volume 33, Issue 1, pages 79–85, January 2013

Additional Information

How to Cite

Alkhouri, N., Sedki, E., Alisi, A., Lopez, R., Pinzani, M., Feldstein, A. E. and Nobili, V. (2013), Combined paediatric NAFLD fibrosis index and transient elastography to predict clinically significant fibrosis in children with fatty liver disease. Liver International, 33: 79–85. doi: 10.1111/liv.12024

Author Information

  1. 1

    Department of Pediatric Gastroenterology, Cleveland Clinic, Cleveland, Ohio, USA

  2. 2

    Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA

  3. 3

    Department of Internal Medicine, Fairview Hospital, Cleveland Clinic, Cleveland, Ohio, USA

  4. 4

    Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA

  5. 5

    Liver Unit, “Bambino Gesù” Children's Hospital and Research Institute, Rome, Italy

  6. 6

    Department of Internal Medicine, Center for Research, High Education and Transfer DENO, The University of Florence, Florence, Italy

  7. 7

    Department of Pediatric Gastroenterology, Rady Children's Hospital, University of California, San Diego, California, USA

* Correspondence
Naim Alkhouri, M.D.
Department of Pediatric Gastroenterology
Cleveland Clinic Foundation
9500 Euclid Avenue
Cleveland, Ohio 44195
Tel: 216-444-9000
Fax: 216-444-2974
e-mail: alkhoun@ccf.org

Publication History

  1. Issue published online: 10 DEC 2012
  2. Article first published online: 12 NOV 2012
  3. Accepted manuscript online: 17 OCT 2012 11:00AM EST
  4. Manuscript Accepted: 4 OCT 2012
  5. Manuscript Received: 3 FEB 2012

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Keywords:

  • children;
  • fibrosis;
  • liver biopsy;
  • nonalcoholic fatty liver disease;
  • noninvasive

Abstract

Background

Nonalcoholic fatty liver disease (NAFLD) encompasses a spectrum of disease from simple steatosis to steatohepatitis, to fibrosis and cirrhosis. The paediatric NAFLD fibrosis index (PNFI) and transient elastography (TE) are potential noninvasive markers for fibrosis.

To prospectively evaluate the performance of PNFI and TE in assessing clinically significant fibrosis in children with biopsy-proven NAFLD.

Methods

Our cohort consisted of 67 consecutive children with biopsy-proven NAFLD. The stage of fibrosis was scored according to the Nonalcoholic Steatohepatitis Clinical Research Network. Fibrosis ≥ 2 was considered clinically significant. PNFI was calculated using age, waist circumference and triglycerides. TE was performed using the Fibroscan apparatus.

Results

Ten patients had fibrosis stage 2–3 and 57 patients had stage 0–1. Both PNFI and TE values were significantly higher in patients with significant fibrosis (P < 0.05). The area under the receiver operating characteristic (ROC) curve for predicting significant fibrosis of PNFI and TE were 0.747 and 1.00 respectively (P = 0.005). The combined use of PNFI and TE could predict the presence or absence of clinically significant fibrosis in 98% of children with NAFLD.

Conclusions

In children with NAFLD, the combination of PNFI and TE can be used to accurately assess the presence of clinically significant liver fibrosis. This will help to identify patients who should undergo liver biopsy because the confirmation of advanced fibrosis would lead to closer follow-up and screening for cirrhosis-related complications.

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