Pathologists may be more interested in this article than many pediatric gastroenterologists (J Hepatol 2012; 57: 1312-18). Yet, the development of the pediatric NAFLD (non-alcoholic fatty liver disease) histological score (PNHS) is likely to be helpful, particularly in research of NAFLD.
In this study, an initial training set of 203 children with biopsy-proven NAFLD were examined. After designing a scoring system, the PNHS was validated in another 100 children. The mean age was 12.4 years.
PNHS = 100 x esp(Zphs)/[1 + exp(Zphs)]
Zphns = -8.4 + (2.5 x steatosis) + (3.5 x ballooning) + (3.4 x lobular inflammation) + (0.87 x portal inflammation)
This score is easily calculated by entering the individual histological features at the following website:
- steatosis 1-3 (1=5%-33%, 2=34%-65%, 3=≥66%)
- ballooning 0-2 (0=none, 1=few, 2=many)
- lobular inflammation 0-3 (0=none, 1=<2 under 20x, 2=2-4 under 20x, 3=>4 under 20x)
- portal inflammation 0-2 (0=none, 1=mild, 2=more than mild)
- http://rcc.simpal.com/RCEval.cgi?RCID=RPCxtv#Result
Results:
- In NASH patients, the mean PNHS was 89 ± 20.5 compared to 21.9 ± 24.5 in the non NASH patients.
- There was a high level of agreement between categorization of NAFLD cases using PNHS compared with pathologist diagnosis.
- NASH patients were much more likely to have metabolic syndrome (64%) compared with 38% for non-NASH patients
- Of the histologic features, ballooning was the feature that most distinguished the cohorts. In 66% of NASH patients, few or many ballooning hepatocytes were noted, whereas 96% of non-NASH patients had no ballooning noted.
- With PNHS of ≥85, the sensitivity is 76-77% and the specificity is 91-97% for NASH. This will decrease the number of ‘borderline NASH’ cases in pediatric cohorts.
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