The discriminatory ability of FibroScan liver stiffness measurement, controlled attenuation parameter, and FibroScan–aspartate aminotransferase to predict severity of liver disease in children

Abstract

Vibration controlled transient elastography (FibroScan) is used to predict the severity of liver fibrosis and steatosis. In pediatrics, few studies have been performed directly comparing liver histologic features with FibroScan liver stiffness measurements (LSMs) and controlled attenuation parameters (CAPs).The FibroScan-aspartate aminotransferase (FAST) score, which predicts liver disease severity in adult nonalcoholic fatty liver disease (NAFLD), has not been analyzed in children. The aims of this study were to determine if LSM and CAP correlated with liver histologic fibrosis stage and steatosis grade, respectively, and to determine the predictive capacity of FAST in pediatric NAFLD. Research participants (n = 216) included those with FibroScan within 90 days of a liver biopsy. The ability of LSM, CAP, and FAST to predict severity of liver disease was analyzed by Spearman correlation, linear regression, and receiver operating characteristic and C statistic. Significant correlations were identified between LSM and Ishak fibrosis stages, with the strongest correlation occurring in the non-NAFLD group (Spearman r = 0.47, p < 0.0001). LSM adequately predicted Ishak stages F0-2 versus F3-F6 (area under the receiver operating characteristic curve [AUROC], 0.73 for all; 0.77 for non-NAFLD). CAP strongly predicted histologic steatosis grade (r = 0.84; p < 0.0001; AUROC, 0.98). FAST had acceptable discriminatory ability for significant liver disease (AUROC, 0.75). A FAST cutoff ≥0.67 had a sensitivity of 89% but a specificity of only 62% at determining significant liver disease.This study encompasses one of the largest pediatric cohorts describing the accuracy of FibroScan LSM and CAP to predict liver histologic fibrosis stage and steatosis grade, respectively. In order to determine specific LSM, CAP, and FAST cut-off values for fibrosis stages, steatosis grades, and significant

Clinical research of fibroscan ‒ TE-CAP at noninvasive diagnosis of hepatic steatosis in children

“… 33 , 34 Previous study had used TE-CAP to predict the severity of liver disease in children. 35 TE-CAP was also used in adolescents without liver disease. 34 Nevertheless, TE-CAP is most commonly used to screen for NAFLD.…”

Clinical profile, referral trends, and real‐world application of vibration‐controlled transient elastography in children with non‐alcoholic fatty liver disease in Singapore

“…LSM cut‐off of ≥5, >7, and >9 kPa have been proposed to rule‐in “any” fibrosis (likelihood ratio, LR 5.923), significant fibrosis (LR 3.167), and advanced fibrosis (LR 22.50), respectively 8,26 . In another study comprising 206 pediatric participants, VCTE‐derived LSM showed significant correlation with fibrosis stage, and was best able to differentiate between Ishak stage F0–F2 versus F3–F6, with AUROC of 0.7 specifically for the NAFLD group 27 . The study also found that CAP score positively correlated with steatosis grade, and a score of ≥259 dB/m was predictive of hepatic steatosis grades 1–3 with sensitivity of 94% and specificity of 91%.…”

Metabolomic Phenotype of Hepatic Steatosis and Fibrosis in Mexican Children Living with Obesity

“…On the other hand, a liver biopsy was not performed, which we know is the gold standard for diagnosing steatosis and hepatic fibrosis; nonetheless, FibroScan ® has been proposed as a non-invasive, painless, reliable, and reproducible method for diagnosing liver damage in children and adolescents [15]. Stiffness, which is determined using transient elastography and considered a consequence of the fibrotic process, is closely related to the histological biopsy findings of fibrosis in children [16,27,50]. Even though we could not evaluate the presence of SH due to a lack of liver biopsies, SH has been described as a progression stage in MASLD that may or may not be associated with fibrosis.…”