Plasma N-terminal propeptide of type III procollagen accurately predicts liver fibrosis severity in children with non-alcoholic fatty liver disease.
BACKGROUND & AIMS
We examined the diagnostic performance of plasma N-terminal propeptide of type III procollagen (PIIINP) levels, aspartate aminotransferase to platelet ratio index (APRI) and Fibrosis-4 (FIB-4) score for predicting non-alcoholic steatohepatitis (NASH) and liver fibrosis stage in children/adolescents with non-alcoholic fatty liver disease (NAFLD).


METHODS
We enrolled 204 children/adolescents with biopsy-proven NAFLD at the "Bambino Gesù" Children's Hospital. We measured plasma PIIINP levels using a commercially available enzyme-linked immunosorbent assay kit and calculated APRI and FIB-4 scores using standard methods.


RESULTS
Children with NASH had higher plasma PIIINP levels, APRI and FIB-4 scores compared with those without NASH (all P < .001). However, PIIINP levels had much better diagnostic performance and accuracy than APRI and FIB-4 scores for predicting liver fibrosis stage. PIIINP levels correlated with the total NAFLD activity score (NAS) and its constituent components (P < .0001). The risk of either NASH or F ≥ 2 fibrosis progressively increased with increasing PIIINP levels (P < .0001), independent of age, gender, adiposity measures, insulin resistance, NAS score and the patatin-like phospholipase domain-containing protein-3 rs738409 polymorphism. For every 3.6 ng/mL increase in PIIINP levels, the likelihood of having F ≥ 2 fibrosis increased by ~14-fold (adjusted-odds ratio 14.1, 95% CI 5.50-35.8, P < .0001) after adjustment for the aforementioned risk factors. The area under the receiver operating characteristics curve was 0.921 (95% CI 0.87-0.97) for F ≥ 2 fibrosis, and 0.993 (95% CI 0.98-1.0) for F3 fibrosis respectively.


CONCLUSIONS
Unlike APRI and FIB-4 scores, plasma PIIINP levels are a promising, non-invasive biomarker for diagnosing liver fibrosis stage in children/adolescents with biopsy-proven NAFLD.
['Mosca|Antonella|A|0000-0001-9646-7462', 'Comparcola|Donatella|D|', 'Romito|Ilaria|I|', 'Mantovani|Alessandro|A|0000-0002-7271-6329', 'Nobili|Valerio|V|0000-0002-4570-3979', 'Byrne|Christopher D|CD|0000-0001-6322-7753', 'Alisi|Anna|A|0000-0001-7241-6329', 'Targher|Giovanni|G|0000-0002-4325-3900']
D000293:Adolescent D015415:Biomarkers D016022:Case-Control Studies D002648:Child D002675:Child, Preschool D005260:Female D006801:Humans D008099:Liver D008103:Liver Cirrhosis D008297:Male D065626:Non-alcoholic Fatty Liver Disease D010446:Peptide Fragments D011347:Procollagen D012720:Severity of Illness Index
procollagen liver fibrosis children PIIINP NAFLD