ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
Diagnostic value of non-invasive indices for assessing liver fibrosis in Chinese children with metabolic dysfunction-associated steatotic liver disease
Provisionally accepted
- Hunan Children's Hospital, Changsha, China
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Introduction and objectives: The rising prevalence of metabolic dysfunction-associated steatotic liver disease (MASLD) in Chinese children necessitates non-invasive fibrosis assessment. However, there is a paucity of pediatric-specific diagnostic tools. The objective of this study was to evaluate the performance of seven established non-invasive indices for staging liver fibrosis in Chinese children with biopsy-proven MASLD. Materials and methods: A cross-sectional analysis was conducted in children with MASLD. Liver fibrosis staging (F0-F4) was determined via histological assessment. The diagnostic performance of seven non-invasive indices (APRI, FIB-4, PNFI, TyG, AAR, API, NFS) was evaluated using Spearman correlation analysis and area under the receiver operating characteristic curve (AUROC) analysis. Results: A total of 110 children were included in the study, among whom significant fibrosis (F ≥2) was present in 36.3% (40/110), including 12.7% with F3 and 2.7% with cirrhosis (F4). When analyzing the correlations between indices and fibrosis stages, only modest positive correlations were observed for APRI (r=0.32), FIB-4 (r=0.23), PNFI (r=0.24) and TyG (r=0.24) (all P < 0.05), while AAR, API and NFS had no significant correlations (all P > 0.05). All indices exhibited poor diagnostic accuracy, with AUROCs ranging from 0.49 to 0.69 across all fibrosis stages. Specifically, APRI, FIB-4 and TyG showed analogous AUROCs (0.60-0.69) for diagnosing any (F ≥1), significant (F ≥2) and severe (F ≥3) fibrosis. Conversely, AAR, API and NFS demonstrated even poorer performance, with AUROCs ranging from 0.49 to 0.60. Conclusion: The non-invasive fibrosis indices that have been validated demonstrated poor diagnostic accuracy and unreliable performance in Chinese children with MASLD. This diagnostic gap emphasizes the urgent need for the development of pediatric-specific diagnostic algorithms tailored for MASLD-related liver fibrosis.
Keywords: Children, Chinese, liver fibrosis, Metabolic dysfunction-associated steatotic liver disease, Non-invasive indicators
Received: 29 Aug 2025; Accepted: 10 Dec 2025.
Copyright: © 2025 Zhou, Liu, Qiu, Ouyang, Zhu, Chen, Li and Zhao. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Hongmei Zhao
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