6348 Lessons from a fibroscan in a paediatric clinic for metabolic dysfunction-associated steatotic liver disease (MASLD)

Objectives Fibroscan is used to assess for liver fibrosis and steatosis non-invasively, quantifying liver stiffness and controlled attenuation parameter (CAP). Both respectively correlate with liver fibrosis and steatosis. In this audit we identified correlations between fibroscan markers of liver stiffness and steatosis, and anthropometry, ultrasound and biochemical liver function tests. Methods All patients seen between January-October 2023 in the MASLD clinic of a tertiary paediatric hepatology department were eligible for inclusion. Their ultrasound, Fibroscan, liver biochemistry and anthropometry z-scores were recorded. Data analysis with IBM® SPSS® using Independent t-test and Pearson's correlation. Statistical significance at p<0.05(*) and p<0.01(**). Results 76 children (49M:27F) were identified. Median and range were as follows: Age: 15 years (6–18 years); z-score for weight 2.9 (-1.1 to 5.3), for height 0.6 (-1.8 to 4.5) and for BMI 2.9 (-1.4 to 5.3). On ultrasound, 10 had mild or no steatosis and 37 had splenomegaly interpreted as indirect evidence of liver fibrosis. On fibroscan, median liver stiffness was 6.1kPa (3.3 to 16.9) and median steatosis CAP 298 dB/m (185 to 400). Steatosis per fibroscan: 23 children had no or mild steatosis (<260dB/m) and 53 had significant (moderate or severe) steatosis (>260dB/m). Compared with the others the group with significant steatosis had higher mean AST (43 vs 24 IU/L)**, ALT (81 vs 28 IU/L)** and GGT ( 43 vs 26 IU/L)**, and higher average weight z-score was higher: 3 vs 2.3*, as was BMI z-score (2.9 vs 2.2)*. Fibrosis per fibroscan: 45 children had evidence of no or mild fibrosis and 31 children had evidence of significant (moderate or severe) fibrosis. The children with significant fibrosis had higher average ALT (89 vs 48 IU/L)**, AST (48 vs 30 IU/L)**, GGT (49 vs 30 IU/L)**, and higher height z-score (1 vs 0.5)* and BMI z-score (3 vs 2.5)*. Their CAP was higher (314 vs 284 dB/m)*, indicating severe steatosis vs moderate. Liver stiffness and steatosis correlated with ALT**, AST**, GGT** and with BMI** and Weight z-score*. There was a positive significant correlation between liver stiffness and steatosis. Conclusion The majority of the children among this young population with MASLD had evidence of significant steatosis and mild fibrosis both of which are completely reversible at this stage. This would be the ideal time for effective intervention to delay progression to severe fibrosis and cirrhosis.