1. Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease.
- Author
-
Draijer, Laura G., Feddouli, Sana, Bohte, Anneloes E., vd Baan Slootweg, Olga, Pels Rijcken, Tammo H., Benninga, Marc A., Stoker, Jaap, and Koot, Bart G. P.
- Subjects
- *
FATTY liver , *PROTON magnetic resonance spectroscopy , *CHILDHOOD obesity , *ALANINE aminotransferase , *COMPARATIVE studies , *RESEARCH methodology , *MEDICAL cooperation , *NUCLEAR magnetic resonance spectroscopy , *RESEARCH , *ULTRASONIC imaging , *EVALUATION research , *PREDICTIVE tests , *CROSS-sectional method , *SEVERITY of illness index , *RECEIVER operating characteristic curves , *DISEASE complications - Abstract
Alanine aminotransferase (ALT) and ultrasound (US) are the most commonly used tools for detecting non-alcoholic fatty liver disease (NAFLD). No direct comparison of these two modalities in children exists. We aimed to compare head-to-head the diagnostic accuracy of ALT and US and their combination for detecting NAFLD in children with obesity. Ninety-nine children with severe obesity underwent simultaneous serum-ALT and abdominal ultrasound (US steatosis score 0-3). Proton magnetic resonance spectroscopy was used as reference standard for detecting steatosis/NAFLD. ROC curve analyses were performed to determine diagnostic performance and to determine optimum screening cut-points aiming for a specificity ≥ 80%. The area under the ROC (AUROC) of ALT and US were not significantly different (0.74 and 0.70, respectively). At the optimal ALT threshold (≥40 IU/L), sensitivity was 44% and specificity was 89%. At the optimal US steatosis score (≥ 2), sensitivity was 51% and specificity was 80%. Combining ALT and US did not result in better accuracy than ALT or US alone.Conclusion: ALT and US have comparable and only moderate diagnostic accuracy for detecting hepatic steatosis in children with obesity. A stepwise screening strategy combining both methods does not improve diagnostic accuracy. What is Known: • Alanine aminotransferase (ALT) and ultrasound (US) are the most commonly used tools for detecting non-alcoholic fatty liver disease (NAFLD). • ALT and ultrasound have mediocre accuracy in detecting steatosis in children with obesity. What is New: • In a head-to-head comparison, the difference in diagnostic accuracy of ALT and ultrasound in detecting steatosis is not significant. • A stepwise screening strategy combining both methods does not improve diagnostic accuracy. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF