Laura G Draijer1,2,3, Janneke P M van Oosterhout1, Yasaman Vali4, Sabrina Zwetsloot1, Johanna H van der Lee5, Faridi S van Etten-Jamaludin6, Malika Chegary7, Marc A Benninga1, Bart G P Koot1. 1. Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers, Location Academic Medical Center, Emma Children's Hospital, University of Amsterdam, the Netherlands. 2. Amsterdam Reproduction & Development Research Institute, Amsterdam University Medical Centers, Location Academic Medical Center, Emma Children's Hospital, Amsterdam, the Netherlands. 3. Amsterdam UMC, University of Amsterdam, Gastroenterology and Hepatology, Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam, Netherlands. 4. Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Location Academic Medical Center, University of Amsterdam, the Netherlands. 5. Paediatric Clinical Research Office, Amsterdam University Medical Centers, Location Academic Medical Center/Emma Children's Hospital, University of Amsterdam, and Knowledge Institute of the Dutch Federation of Medical Specialists, Utrecht, the Netherlands. 6. Amsterdam UMC, University of Amsterdam, Research Support, Medical Library AMC, Amsterdam, Netherlands. 7. Department of Paediatrics, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands.
Abstract
BACKGROUND AND AIMS: Non-Alcoholic Fatty Liver disease (NAFLD) has become the most common chronic liver disease in children. Even at young age it can progress to liver fibrosis. Given the drawbacks of liver biopsy, there is a need for non-invasive methods to accurately stage liver fibrosis in this age group. In this systematic review we evaluate the diagnostic accuracy of non-invasive methods for staging liver fibrosis in children with NAFLD. METHODS: We searched MEDLINE, Embase, Web of Science and the Cochrane Library, for studies that evaluated the performance of a blood-based biomarker, prediction score, or imaging technique in staging liver fibrosis in children with NAFLD, using liver biopsy as the reference standard. RESULTS: Twenty studies with a total of 1787 NAFLD subjects were included, that evaluated three prediction scores, five simple biomarkers, two combined biomarkers and six imaging techniques. Most studies lacked validation. Substantial heterogeneity of studies and limited available study data precluded a meta-analysis of the few fibrosis tests evaluated in more than one study. The most consistent accuracy data were found for transient elastography by FibroScan®, ELF test and ultrasound elastography, with an area under the receiver operating characteristics curve varying between 0.92 and 1.00 for detecting significant fibrosis. CONCLUSION: Due to the lack of validation, the accuracy and clinical utility of non-invasive fibrosis tests in children with NAFLD remains uncertain. As studies have solely been performed in tertiary care settings, accuracy data cannot directly be translated to screening populations. This article is protected by copyright. All rights reserved.
BACKGROUND AND AIMS: Non-Alcoholic Fatty Liver disease (NAFLD) has become the most common chronic liver disease in children. Even at young age it can progress to liver fibrosis. Given the drawbacks of liver biopsy, there is a need for non-invasive methods to accurately stage liver fibrosis in this age group. In this systematic review we evaluate the diagnostic accuracy of non-invasive methods for staging liver fibrosis in children with NAFLD. METHODS: We searched MEDLINE, Embase, Web of Science and the Cochrane Library, for studies that evaluated the performance of a blood-based biomarker, prediction score, or imaging technique in staging liver fibrosis in children with NAFLD, using liver biopsy as the reference standard. RESULTS: Twenty studies with a total of 1787 NAFLD subjects were included, that evaluated three prediction scores, five simple biomarkers, two combined biomarkers and six imaging techniques. Most studies lacked validation. Substantial heterogeneity of studies and limited available study data precluded a meta-analysis of the few fibrosis tests evaluated in more than one study. The most consistent accuracy data were found for transient elastography by FibroScan®, ELF test and ultrasound elastography, with an area under the receiver operating characteristics curve varying between 0.92 and 1.00 for detecting significant fibrosis. CONCLUSION: Due to the lack of validation, the accuracy and clinical utility of non-invasive fibrosis tests in children with NAFLD remains uncertain. As studies have solely been performed in tertiary care settings, accuracy data cannot directly be translated to screening populations. This article is protected by copyright. All rights reserved.