Related Experiment Video
Updated: Jun 20, 2025
Author Spotlight: Advancing Hepatic Fibrosis Diagnosis Using Magnetic Resonance Elastography and AI
Published on: July 21, 2023
Development and validation of pFIB scores for exclusion of significant liver fibrosis in pediatric MASLD
Sander Lefere1,2, Antonella Mosca3, Christian Hudert4
1Hepatology Research Unit, Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.
Insights
New risk scores accurately identify children with metabolic dysfunction-associated steatotic liver disease (MASLD) and significant fibrosis. These scores aid in excluding fibrosis in pediatric obesity cases, improving diagnostic accuracy.
Area of Science:
- Pediatric Hepatology
- Metabolic Disorders
- Liver Fibrosis Diagnostics
Background:
- Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most common liver condition in children.
- Accurate risk stratification tools for identifying pediatric MASLD-associated liver fibrosis are lacking.
Purpose of the Study:
- To develop and validate novel risk scores for excluding significant liver fibrosis in children and adolescents with MASLD.
- To compare the performance of new scores against existing noninvasive fibrosis indices.
Main Methods:
- Prospective cohort study of 327 children and adolescents with severe obesity.
- Development of continuous (pFIB-c) and simplified (pFIB-6) scores using logistic regression.
- Validation in elastography (n=504) and biopsy-proven MASLD (n=261) cohorts.
Main Results:
- The pFIB-c and pFIB-6 scores demonstrated good discriminatory capacity (c-statistics 0.839 and 0.826), outperforming existing scores.
- Both scores achieved negative predictive values >90% for excluding significant fibrosis in derivation and elastography cohorts.
- Performance varied in histological cohorts, with lower accuracy in tertiary referral centers.
Conclusions:
- Novel risk scores (pFIB-c, pFIB-6) were developed using readily available clinical variables for pediatric MASLD-associated fibrosis.
- The scores are effective in excluding fibrosis in nonselected pediatric obesity cohorts.
- Scores performed better in general obesity populations than in highly selected tertiary referral populations.
Background And Aims:
Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent pediatric liver disease, yet accurate risk scores for referral of children/adolescents with suspected clinically significant liver fibrosis are currently lacking.
Approach And Results:
Clinical and biochemical variables were collected in a prospective cohort of 327 children and adolescents with severe obesity, in whom liver fibrosis was evaluated by transient elastography. Logistic regression was performed to establish continuous (pFIB-c) and simplified (pFIB-6) diagnostic scores that accurately exclude significant (≥F2) fibrosis. Performance for each was compared to established noninvve fibrosis scores. These scores were validated in elastography (n=504) and multiple biopsy-proven MASLD (n=261) cohorts. Patient sex, ethnicity, weight z-score, homeostatic model assessment of insulin resistance index, ALT, and presence of hypertension were included in the scores. The pFIB-c and pFIB-6 exhibited good discriminatory capacity (c-statistic of 0.839 and 0.826), outperforming existing indices. Negative predictive values were >90% for both scores in the derivation and elastography validation cohorts. Performance in the histological cohorts varied (AUROCs for the pFIB-c between 0.710 and 0.770), as the scores were less accurate when applied to populations in tertiary referral centers characterized by a high prevalence of significant fibrosis and high ALT levels.
Conclusions:
Analyzing several cohorts totaling approximately 1100 children and adolescents, we developed novel risk scores incorporating readily available clinical variables. In accordance with the aim of excluding pediatric MASLD-associated fibrosis, the scores performed better in nonselected cohorts of children and adolescents living with obesity than in patients referred to tertiary liver units.
