Oladuni D. Cummings-John, MD1, Stephenie Geistweidt1, Toluwalase C. Okubote, MD1, Johanna M. Ascher Bartlett, MD2, Jean Filo, BS3, Amanda Betancourt, PA-C1, Naim Alkhouri, MD1, Eric Lawitz, MD4, Candice Angueira1
1Texas Liver Institute, San Antonio, TX; 2University of Texas Health Science Center, San Antonio, TX; 3University of Delaware, Wilmington, DE; 4Texas Liver Institute, University of Texas Health, San Antonio, TX
Introduction: Estimating the severity of liver steatosis by controlled attenuation parameter (CAP) and liver fibrosis by transient elastography (TE) using the FibroscanTM machine provides a noninvasive method to establish the presence of nonalcoholic fatty liver disease (NAFLD) and assess its severity. The use of CAP/TE is becoming routine practice in adults yet limited data exists in children with suspected NAFLD. The aim of this study was to assess the feasibility and utility of measuring CAP/TE by FibroscanTM in a cohort of children with suspected NAFLD.
Methods: All children referred with a clinical suspicion of NAFLD (elevated alkaline phosphatase (ALT) or fatty infiltration on ultrasonography) who had CAP/TE measured were included. FibroscanTM testing was performed on a standardized machine with an experienced operator utilizing a medium (M) or extra-large (XL) probe. Standard criteria for having valid measurements were applied (IQR < 30% with > 70% success rate). Severity of steatosis was evaluated based on the following cutoffs for CAP: < 225 db/m (no steatosis), 225-250 db/m (mild steatosis), 250-300 db/m (moderate steatosis), >300 db/m (severe steatosis). Severity of liver stiffness was evaluated using the following TE cutoffs: < 6 kPa (no fibrosis), 6-10 kPa (mild to moderate fibrosis), >10 kPa (advanced fibrosis). Baseline clinical and laboratory parameters were also collected.
Results: 119 children with suspected NAFLD were referred to the clinic between May 2017 and April 2019. The mean age at time of assessment was 13.0 (± 3.0) years. The majority were males (68%), obese (87%) and of Hispanic ethnicity (77%). The M probe was used to successfully complete 64% of scans whereas the XL probe was required for 36% of scans. 4/116 (3%) had a CAP < 225 indicating no steatosis. 15/116 (13%) of patients fell within the mild steatosis range (CAP 225-250), 31/116 (27%) with moderate steatosis (CAP 250-300) and the majority, 66/116 (57%), of patients having severe steatosis with CAP values > 300. On TE, 50% had no fibrosis, 45% with mild to moderate fibrosis and 7% with advanced fibrosis. Linear regression analysis demonstrated a weakly positive correlation between baseline ALT and TE measurements (correlation coefficient (r) was 0.24; P value < 0.05; Figure 1.1).
Discussion: CAP/TE provides a reliable way to confirm the diagnosis of NAFLD and assess its severity in children. Larger pediatric studies that assess the correlation with liver histology and disease progression are needed.
Citation: Oladuni D. Cummings-John, MD; Stephenie Geistweidt; Toluwalase C. Okubote, MD; Johanna M. Ascher Bartlett, MD; Jean Filo, BS; Amanda Betancourt, PA-C; Naim Alkhouri, MD; Eric Lawitz, MD; Candice Angueira. P1522 - FIBROSCAN IS A FEASIBLE AND USEFUL POINT-OF-CARE TOOL TO ASSESS NONALCOHOLIC FATTY LIVER DISEASE SEVERITY IN CHILDREN TEXAS LIVER INSTITUTE, UNIVERSITY OF TEXAS (UT) HEALTH SAN ANTONIO, SAN ANTONIO, TX. Program No. P1522. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.