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The development of the pediatric NAFLD fibrosis score (PNFS) to predict the presence of advanced fibrosis in children with nonalcoholic fatty liver disease
- Source :
- PLoS ONE, Vol 9, Iss 8, p e104558 (2014), PLoS ONE
- Publication Year :
- 2014
- Publisher :
- Public Library of Science (PLoS), 2014.
-
Abstract
- Background Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. The aims of our study were 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. 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. 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: 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. Conclusion Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric NAFLD fibrosis score with improved performance characteristics.
- Subjects :
- Blood Platelets
Liver Cirrhosis
Male
medicine.medical_specialty
Pathology
Cirrhosis
Biopsy
lcsh:Medicine
Nonalcoholic Steatohepatitis
Gastroenterology and Hepatology
Logistic regression
Gastroenterology
Severity of Illness Index
digestive system
Chronic Liver Disease
Fibrosis
Non-alcoholic Fatty Liver Disease
Internal medicine
Nonalcoholic fatty liver disease
Severity of illness
medicine
Medicine and Health Sciences
Humans
Aspartate Aminotransferases
Child
lcsh:Science
Multidisciplinary
biology
business.industry
Platelet Count
Liver Diseases
Fatty liver
lcsh:R
Alanine Transaminase
medicine.disease
Alkaline Phosphatase
digestive system diseases
Fatty Liver
Logistic Models
Alanine transaminase
biology.protein
Female
lcsh:Q
business
Hepatic fibrosis
Agricultural and Biological Sciences (all)
Biochemistry, Genetics and Molecular Biology (all)
Medicine (all)
Research Article
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 9
- Issue :
- 8
- Database :
- OpenAIRE
- Journal :
- PLoS ONE
- Accession number :
- edsair.doi.dedup.....8ea4d3585ef472c9b7631a0be67ea5d6