Table 3.

The usefulness of hepatic fibrosis scoring systems in pediatric patients diagnosed with NAFLD

Hepatic fibrosis score	Parameters used	Accuracy in pediatric patients
AST/ALT ratio	AST, ALT	Very low [6, 9]
APRI	AST, platelets	High [9]
Forns index	Total bilirubin, GGT, α2-macroglobulin, apolipoprotein A1, haptoglobin.	Moderate [9]
FIB-4 score	Age, AST, ALT, platelets	High accuracy in differentiating significant from mild fibrosis [9].
ELF test	HA, PIIINP, TIMP-1	Good accuracy for differentiating significant fibrosis (stage 3) from mild or no fibrosis (AUROC=0.99, 10.51 cutoff) [4].
PNFI	Age, waist circumference, triglyceride level.	Good accuracy for differentiating hepatic fibrosis from no fibrosis (AUROC=0.85, 0.76 respectively) [3, 10].
PNFI + ELF test	–	Excellent accuracy for the prediction of hepatic fibrosis (AUROC=0.94) [3].

ALT: Alanine aminotransferase; APRI: AST to platelet ratio index; AST: Aspartate aminotransferase; AUROC: Area under the receiver operating characteristics curve; ELF: Enhanced liver fibrosis; FIB-4: Fibrosis-4; GGT: Gamma-glutamyl transferase; HA: Hyaluronic acid; NAFLD: Non-alcoholic fatty liver disease; PIIINP: Procollagen III N-terminal peptide; TIMP-1: Tissue inhibitor of metalloproteinase-1; PNFI: Pediatric NAFLD fibrosis index