Performance of fibrosis prediction scores in paediatric non‐alcoholic fatty liver disease

Aim Non‐alcoholic fatty liver disease (NAFLD) is the leading cause of chronic liver disease in children. The phenotype of NAFLD varies widely, and non‐invasive predictors of disease severity are scarce and are needed to tailor clinical management. Methods We compared liver fibrosis by histology with proposed non‐invasive predictors of fibrosis, including alanine transaminase (ALT), aspartate transaminase (AST), AST/ALT ratio, AST to platelet ratio index, fibrosis‐4, paediatric NAFLD fibrosis index and paediatric NAFLD fibrosis score. Results The area under the curve of scores obtained while predicting fibrosis in children with NAFLD ranged from 0.51 to 0.67. Conclusion The tested non‐invasive fibrosis scoring systems, some of which were originally designed for adult populations, did not adequately predict fibrosis in a paediatric cohort. Further development of risk prediction scores in children are needed for the management of paediatric patients and will likely need to be developed within a large paediatric data set in order to improve specificity and sensitivity.