Can Baseline Characteristics be Used to Predict Liver Disease Outcomes in Pediatric Nonalcoholic Fatty Liver Disease?

Abstract

Objective: Longitudinal studies on childhood predictors of nonalcoholic fatty liver disease (NAFLD) progression are lacking. The objective of this study was to determine whether baseline clinical or laboratory measures predict liver disease outcomes in a pediatric NAFLD cohort. Methods: A retrospective study of patients with presumed NAFLD was conducted using baseline and follow-up clinical and laboratory measures. Disease outcomes were defined using the mean serum alanine aminotransferase (ALT) levels from 24 to 36 months after the first visit. Logistic regression assessed the relationship between ALT progression/ regression and predictor variables. Multivariable regression determined the best model for predicting the ALT outcome. Markov process modeling explored the likelihood for a patient to transition between ALT states. Results: Of a total of 816 patients identified, 144 had sufficient data. Regression was seen in 26%, whereas 30% progressed. No baseline clinical or laboratory measurements had a significant effect on disease outcomes. Markov modeling demonstrated that subjects were more likely to either remain in their baseline ALT group or worsen rather than improve. Conclusions: Routinely obtained baseline clinical or laboratory measures cannot help risk-stratify youth with presumed NAFLD in terms of long-term outcomes. Close clinical, radiographic, and histologic evaluation of patients is warranted to determine those at risk of progression.

Evaluation of the feasibility of screening for paediatric non‐alcoholic fatty liver disease

“…Furthermore, paediatric NAFLD in a community setting does not seem to progress rapidly: ALT increases in 30% of the children after 2–3 years and normalises in 26%, although the progression to fibrosis in the general population is still unknown. 33 The exact cost‐effectiveness of screening remains to be established, wherein the costs of screening should be balanced with the risk of missing rare diseases. Thirdly, it was perceived as a problem that the guideline does not correspond with other guidelines.…”

“…It should be noted that in those patients with ALT >80 IU/L, alternative diagnoses are more common 28 and alertness on the presence of other disorders is important in all cases. Furthermore, paediatric NAFLD in a community setting does not seem to progress rapidly: ALT increases in 30% of the children after 2–3 years and normalises in 26%, although the progression to fibrosis in the general population is still unknown 33 . The exact cost‐effectiveness of screening remains to be established, wherein the costs of screening should be balanced with the risk of missing rare diseases.…”

Non‐Invasive Approaches to Estimate Liver Steatosis and Stiffness in Children With Non‐Alcoholic Fatty Liver Disease

“…In addition, clinicians are often hesitant to obtain liver biopsies for the indication of NAFLD (6). Serologic markers, such as ALT, are of limited value, as NAFLD can occur in patients with normal ALT levels (9)(10)(11). Similarly, ultrasonography, which is also often used for the identification of NAFLD, currently has suboptimal sensitivity and specificity in determining the presence and quantifying the severity of steatosis and fibrosis (8).…”