{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T23:39:40Z","timestamp":1783381180547,"version":"3.54.6"},"reference-count":40,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2021,5,11]],"date-time":"2021-05-11T00:00:00Z","timestamp":1620691200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Non\u2010alcoholic fatty liver disease (NAFLD) has become the most common chronic liver disease in children. Even at young age, it can progress to liver fibrosis. Given the drawbacks of liver biopsy, there is a need for non\u2010invasive methods to accurately stage liver fibrosis in this age group. In this systematic review, we evaluate the diagnostic accuracy of non\u2010invasive methods for staging liver fibrosis in children with NAFLD.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched MEDLINE, Embase, Web of Science and the Cochrane Library, for studies that evaluated the performance of a blood\u2010based biomarker, prediction score or imaging technique in staging liver fibrosis in children with NAFLD, using liver biopsy as the reference standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twenty studies with a total of 1787 NAFLD subjects were included, which evaluated three prediction scores, five simple biomarkers, two combined biomarkers and six imaging techniques. Most studies lacked validation. Substantial heterogeneity of studies and limited available study data precluded a meta\u2010analysis of the few fibrosis tests evaluated in more than one study. The most consistent accuracy data were found for transient elastography by FibroScan\u00ae, ELF test and ultrasound elastography, with an area under the receiver operating characteristics curve varying between 0.92 and 1.00 for detecting significant fibrosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Due to the lack of validation, the accuracy and clinical utility of non\u2010invasive fibrosis tests in children with NAFLD remains uncertain. As studies have solely been performed in tertiary care settings, accuracy data cannot directly be translated to screening populations.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.14908","type":"journal-article","created":{"date-parts":[[2021,4,24]],"date-time":"2021-04-24T17:39:59Z","timestamp":1619285999000},"page":"2087-2100","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":37,"title":["Diagnostic accuracy of fibrosis tests in children with non\u2010alcoholic fatty liver disease: A systematic review"],"prefix":"10.1111","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1840-1692","authenticated-orcid":false,"given":"Laura G.","family":"Draijer","sequence":"first","affiliation":[{"name":"Department of Pediatric Gastroenterology and Nutrition Amsterdam University Medical Centers Academic Medical Center Emma Children's Hospital University of Amsterdam Amsterdam The Netherlands"},{"name":"Amsterdam Reproduction &amp; Development Research Institute Amsterdam University Medical Centers Academic Medical Center Emma Children's Hospital Amsterdam The Netherlands"},{"name":"Amsterdam UMC University of Amsterdam Gastroenterology and Hepatology Amsterdam Gastroenterology Endocrinology Metabolism Research Institute Amsterdam Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janneke P. 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