AUTHOR=Mosca Antonella , Della Volpe Luca , Alisi Anna , Veraldi Silvio , Francalanci Paola , Maggiore Giuseppe 

TITLE=Non-Invasive Diagnostic Test for Advanced Fibrosis in Adolescents With Non-Alcoholic Fatty Liver Disease

JOURNAL=Frontiers in Pediatrics

VOLUME=Volume 10 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/pediatrics/articles/10.3389/fped.2022.885576

DOI=10.3389/fped.2022.885576

ISSN=2296-2360

ABSTRACT=NAFLD is a multifaceted disease that includes a wide spectrum of liver damage. The presence and the degree of fibrosis is considered an important factor for the prognosis of NAFLD and in predicting the risk of developing cirrhosis.  Our aim was to evaluate the usefulness of four fibrosis scores (APRI, FIB-4, NFS and Hepamet) in predicting different degree of fibrosis among children with biopsy-proven NAFLD.

Methods: 286 adolescents [mean age 14.3 years ± 2.5; 154 (53.6%) males], referred between January 2014 and December 2019, with biopsy-proven NAFLD were enrolled. 
Results: 173 (60.4%) patients presented fibrosis at histological analysis. In particular: 140 (49.3%) patients had  F=1, 31 (10.8%), had F=2 and 2 (0.66%) had F=3. APRI (AUROC 0.619, 95% CI 0.556–0.679) and Hepamet (AUROC 0.778, 95% CI 0.722-0.828) scores had significant (p<0.001) accuracy to distinguish subjects with fibrosis; while NFS and FIB-4 had not. APRI had a PPV of 62.77% (95% CI 57.96-67.35) and an NPV of 52.01% (95% CI 46.54-57.43); Hepamet a PPV of 63.24% (95% CI 59.95-66.41) and an NPV of 61.29% (52.9-69.01). 
Conclusions: Our study showed that Hepamet and APRI perform better than NFS and FIB-4 for identifying fibrosis in NAFLD patients, but do not have PPVs so high to be considered diagnostic. Therefore, they cannot be employed, in children, for a certain diagnosis of fibrosis or its progression and cannot replace liver biopsy as the gold diagnostic standard. It is therefore necessary to continue to research and develop new markers of exclusive fibrosis.