Serologic biomarkers and scoring systems for hepatic fibrosis in obese children with nonalcoholic steatohepatitis

ObjectivesThe prevalence of nonalcoholic steatohepatitis (NASH) is increasing with the increasing prevalence of childhood obesity. Although NASH has a high risk of progression to liver fibrosis and cirrhosis, few studies have reported on noninvasive markers for predicting hepatic fibrosis in children. This study aimed to evaluate and compare the diagnostic accuracy of serologic biomarkers and scoring systems for hepatic fibrosis in obese children with NASH. MethodsA total of 99 children were diagnosed with NASH based on liver biopsy findings, and divided into two groups according to the degree of liver fibrosis: mild (stage 0-1) or advanced (stage 2-4). Clinical and laboratory parameters and serum levels of hyaluronic acid and type IV collagen were measured. Moreover, the aspartate aminotransferase/platelet ratio index (APRI) and fibrosis-4 (FIB-4) score were calculated. ResultsAmong the noninvasive markers, only serum type IV collagen level and FIB-4 revealed significant differences between the two fibrosis groups. The area under the receiver operating curve of each biomarker and scoring system was 0.80 (95% confidence interval [CI]: 0.70-0.90) for type IV collagen at an optimal cutoff of 148 ng/mL (sensitivity 69.8%, specificity 84.6%), followed by 0.69 (95% CI: 0.57-0.83) for APRI, 0.68 (95% CI: 0.56-0.80) for FIB-4, and 0.65 (95% CI: 0.53-0.77) for hyaluronic acid. ConclusionsType IV collagen as a single noninvasive serologic biomarker for hepatic fibrosis and FIB-4 as a hepatic fibrosis score are beneficial in predicting advanced hepatic fibrosis, and in determining proper diagnosis and treatment strategies before fibrosis progresses in obese children with NASH. Why was this study done?With the increase of the obese population of children and adolescents, the prevalence of nonalcoholic fatty liver disease is increasing. Non-alcoholic steatohepatitis has a high risk of developing liver fibrosis and cirrhosis. However, a single non-invasive serological marker that can predict fatty liver fibrosis in children and adolescents has not been clearly presented. What did the researchers do and find?We evaluate diagnostic accuracy of serological biomarkers and scoring systems for hepatic fibrosis in obese children with NASH. What do these findings mean?Type IV collagen is a useful single noninvasive serological biomarker for hepatic fibrosis. Therefore, it is useful in making appropriate diagnosis and treatment decisions before fibrosis progresses in obese children with non-alcoholic steatohepatitis.