Serum ferritin level as a noninvasive marker for detection and staging of hepatocellular injury, liver fibrosis, and steatosis in children and adolescents with nonalcoholic fatty liver disease

Background Pediatric nonalcoholic fatty liver disease (NAFLD) is a global health problem. Recently, serum ferritin level (SFL) has been reported to be correlated with NAFLD and the degree of liver fibrosis and steatosis. Aim The aim was to assess serum ferritin level as a noninvasive marker for detection and staging hepatocellular injury, liver fibrosis, and steatosis diagnosed by FibroScan in children and adolescents with NAFLD disease proven with ultrasound. Patients and methods The authors assessed serum ferritin in 40 children with NAFLD diagnosed ultrasonography as well as 20 age-matched and sex-matched healthy controls. The authors also assessed the correlation between SFL and the different stages of hepatic fibrosis and steatosis assessed by FibroScan. Results The authors found thatthe values of serum ferritin were significantly higher in patients than controls (P=0.0001). Moreover, there was a positive correlation between SFL and ultrasonographic grades of liver steatosis, FibroScan liver fibrosis grades, and FibroScan liver steatosis controlled attenuation parameter score and its values among patients with NAFLD. Area under the receiver operating characteristic curve (0.995) shows serum ferritin (ng/ml) has significant sensitivity as a diagnostic marker for liver fibrosis degrees diagnosed by FibroScan and liver steatosis stage diagnosed by FibroScan with area under the receiver operating characteristic curve of 1.000 among the studied patients with NAFLD (P=0.0001). Moreover, it has significant sensitivity as a diagnostic marker for liver steatosis grades diagnosed by abdominal ultrasonography among the studied patients with NAFLD (P=0.0001). Conclusion The data suggest that SFL can be used as a noninvasive marker for diagnosis and staging of hepatocellular injury, liver fibrosis, and steatosis in children and adolescents with NAFLD.