Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease

Laura G. Draijer, Sana Feddouli, Anneloes E. Bohte, Olga vd Baan Slootweg, Tammo H. Pels Rijcken, Marc A. Benninga, Jaap Stoker, Bart G. P. Koot

Research output: Contribution to journalArticleAcademicpeer-review

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.
Original languageEnglish
JournalEuropean Journal of Pediatrics
DOIs
Publication statusPublished - 2019

Cite this

Draijer, Laura G. ; Feddouli, Sana ; Bohte, Anneloes E. ; vd Baan Slootweg, Olga ; Pels Rijcken, Tammo H. ; Benninga, Marc A. ; Stoker, Jaap ; Koot, Bart G. P. / Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease. In: European Journal of Pediatrics. 2019.
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title = "Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease",
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.",
author = "Draijer, {Laura G.} and Sana Feddouli and Bohte, {Anneloes E.} and {vd Baan Slootweg}, Olga and {Pels Rijcken}, {Tammo H.} and Benninga, {Marc A.} and Jaap Stoker and Koot, {Bart G. P.}",
year = "2019",
doi = "10.1007/s00431-019-03362-3",
language = "English",
journal = "European Journal of Pediatrics",
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Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease. / Draijer, Laura G.; Feddouli, Sana; Bohte, Anneloes E.; vd Baan Slootweg, Olga; Pels Rijcken, Tammo H.; Benninga, Marc A.; Stoker, Jaap; Koot, Bart G. P.

In: European Journal of Pediatrics, 2019.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Comparison of diagnostic accuracy of screening tests ALT and ultrasound for pediatric non-alcoholic fatty liver disease

AU - Draijer, Laura G.

AU - Feddouli, Sana

AU - Bohte, Anneloes E.

AU - vd Baan Slootweg, Olga

AU - Pels Rijcken, Tammo H.

AU - Benninga, Marc A.

AU - Stoker, Jaap

AU - Koot, Bart G. P.

PY - 2019

Y1 - 2019

N2 - 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.

AB - 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.

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UR - https://www.ncbi.nlm.nih.gov/pubmed/30903305

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JF - European Journal of Pediatrics

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