Evaluation of hepatic steatosis in obese children and adolescents using immune-inflammatory markers and shear wave elastography

Akçiçek, Mehmet; Dağ, Nurullah

doi:10.15557/jou.2025.0001

Abstract

Aim

To investigate the changes in liver stiffness and immune-inflammatory markers associated with obesity and the degree of hepatic steatosis in obese children and adolescents.

Methods

A total of 76 obese children and adolescents aged 6–18 years, with body mass index percentiles >95th, were included in the study. Patients with metabolic syndrome, diabetes mellitus, and chronic liver disease were excluded. A control group of 44 patients of healthy and normal-weight children was included. Laboratory values from the past month were analyzed using patient records. Shear wave elastography and ultrasound examinations were performed on a single device by the same experienced radiologist.

Results

The systemic immune-inflammation index and pan-immune inflammation values were significantly higher in obese patients with hepatic steatosis compared to obese patients without hepatic steatosis (p <0.001). Liver stiffness values were significantly higher in steatotic patients compared to nonsteatotic patients (p <0.001). A significant difference was observed between hepatic steatosis grades in terms of immune-inflammation index and pan-immune inflammation value values (p <0.001). There was a strong, positive, statistically significant correlation between liver stiffness and immune-inflammation index and pan-immune inflammation value (p <0.05).

Conclusions

Immune-inflammatory biomarkers and shear wave elastography may provide valuable insights into the diagnosis and follow-up of inflammation and fibrosis in the evaluation of hepatic steatosis in obese children and adolescents.

References

Shaunak M, Byrne CD, Davis N, Afolabi P, Faust SN, Davies JH: Non-alcoholic fatty liver disease and childhood obesity. Arch Dis Child 2021; 106: 3–8. doi: 10.1136/archdischild-2019-318063.
Open DOI Search in Google Scholar Back to article
Brunt EM: Pathology of nonalcoholic fatty liver disease. Nat Rev Gastroenterol Hepatol 2010; 7: 195–203. doi: 10.1038/nrgastro.2010.21.
Open DOI Search in Google Scholar Back to article
Vajro P, Lenta S, Socha P, Dhawan A, McKiernan P, Baumann U et al.: Diagnosis of nonalcoholic fatty liver disease in children and adolescents: position paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr 2012; 54: 700–713. doi: 10.1097/MPG.0b013e318252a13f.
Open DOI Search in Google Scholar Back to article
Adams LA, Feldstein AE: Non-invasive diagnosis of nonalcoholic fatty liver and nonalcoholic steatohepatitis. J Dig Dis 2011; 12: 10–16. doi: 10.1111/j.1751-2980.2010.00471.x.
Open DOI Search in Google Scholar Back to article
Yang L, Ling W, He D, Lu C, Ma L, Tang L et al.: Shear wave-based sound touch elastography in liver fibrosis assessment for patients with autoimmune liver diseases. Quant Imaging Med Surg 2021; 11: 1532–1542. doi: 10.21037/qims-20-521.
Open DOI Search in Google Scholar Back to article
Garcovich M, Veraldi S, Di Stasio E, Zocco MA, Monti L, Tomà P et al.: Liver Stiffness in Pediatric Patients with Fatty Liver Disease: Diagnostic Accuracy and Reproducibility of Shear-Wave Elastography. Radiology 2017; 283: 820–827. doi: 10.1148/radiol.2016161002.
Open DOI Search in Google Scholar Back to article
Gharibvand MM, Asare M, Motamedfar A, Alavinejad P, Momeni M: Ultrasound shear wave elastography and liver biopsy to determine liver fibrosis in adult patients. J Family Med Prim Care 2020; 9: 943–949. doi: 10.4103/jfmpc. jfmpc_828_19.
Open DOI Search in Google Scholar Back to article
Petrescu M, Vlaicu SI, Ciumărnean L, Milaciu MV, Mărginean C, Florea M et al.: Chronic Inflammation – A Link between Nonalcoholic Fatty Liver Disease (NAFLD) and Dysfunctional Adipose Tissue. Medicina (Kaunas) 2022; 58: 641. doi: 10.3390/medicina58050641.
Open DOI Search in Google Scholar Back to article
Fontes-Cal TCM, Mattos RT, Medeiros NI, Pinto BF, Belchior-Bezerra M, Roque-Souza B et al.: Crosstalk Between Plasma Cytokines, Inflammation, and Liver Damage as a New Strategy to Monitoring NAFLD Progression. Front Immunol 2021; 12: 708959. doi: 10.3389/fimmu.2021.708959.
Open DOI Search in Google Scholar Back to article
Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W et al.: Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res 2014; 20: 6212–622. doi: 10.1158/1078-0432.CCR-14-0442.
Open DOI Search in Google Scholar Back to article
Tong YS, Tan J, Zhou XL, Song YQ, Song YJ: Systemic immune-inflammation index predicting chemoradiation resistance and poor outcome in patients with stage III non-small cell lung cancer. J Transl Med 2017; 15: 221. doi: 10.1186/s12967-017-1326-1.
Open DOI Search in Google Scholar Back to article
Zhao B, Liu Y, Yang Y, He J: Association of Systemic Immune-Inflammation Index with Non-Alcoholic Fatty Liver Disease: A Population-Based Cross-Sectional Study. Risk Manag Healthc Policy 2023; 16: 1581-1592. doi: 10.2147/RMHP.S419183.
Open DOI Search in Google Scholar Back to article
Song Y, Guo W, Li Z, Guo D, Li Z, Li Y: Systemic immune-inflammation index is associated with hepatic steatosis: Evidence from NHANES 2015–2018. Front Immunol 2022; 13: 1058779. doi: 10.3389/fimmu.2022.1058779.
Open DOI Search in Google Scholar Back to article
Hai-Jing Y, Shan R, Jie-Qiong X: Prognostic significance of the pretreatment pan-immune-inflammation value in cancer patients: an updated meta-analysis of 30 studies. Front Nutr 2023; 10: 1259929. doi: 10.3389/fnut.2023.1259929.
Open DOI Search in Google Scholar Back to article
Fucà G, Guarini V, Antoniotti C, Morano F, Moretto R, Corallo S et al.: The Pan-Immune-Inflammation Value is a new prognostic biomarker in metastatic colorectal cancer: results from a pooled-analysis of the Valentino and TRIBE first-line trials. Br J Cancer 2020; 123: 403–409. doi: 10.1038/s41416-020-0894-7.
Open DOI Search in Google Scholar Back to article
Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F, Baş F: Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. J Clin Res Pediatr Endocrinol 2015; 7: 280–293. doi: 10.4274/jcrpe.2183.
Open DOI Search in Google Scholar Back to article
Joo I, Kim SY, Park HS, Lee ES, Kang HJ, Lee JM: Validation of a New Point Shear-Wave Elastography Method for Noninvasive Assessment of Liver Fibrosis: A Prospective Multicenter Study. Korean J Radiol 2019; 20: 1527–1535. doi: 10.3348/kjr.2019.0109.
Open DOI Search in Google Scholar Back to article
Dag N, Sinanoglu MS: Evaluation of meniscal elasticity using shear wave elastography in obese children and adolescents: a preliminary cross-sectional study. Pediatr Radiol 2024; 54: 293–298. doi: 10.1007/s00247-023-05836-x.
Open DOI Search in Google Scholar Back to article
Saadeh S, Younossi ZM, Remer EM, Gramlich T, Ong JP, Hurley M et al.: The utility of radiological imaging in nonalcoholic fatty liver disease. Gastroenterology 2002; 123: 745–750. doi: 10.1053/gast.2002.35354.
Open DOI Search in Google Scholar Back to article
Vergniol J, Foucher J, Terrebonne E, Bernard PH, le Bail B, Merrouche W et al.: Noninvasive tests for fibrosis and liver stiffness predict 5-year outcomes of patients with chronic hepatitis C. Gastroenterology 2011; 140: 1970–1979, 1979.e1-3. doi: 10.1053/j.gastro.2011.02.058.
Open DOI Search in Google Scholar Back to article
Constantinescu C, Săndulescu L, Săftoiu A: The Role of Elastography in Non-Alcoholic Fatty Liver Disease. Curr Health Sci J 2020; 46: 255–269. doi: 10.12865/CHSJ.46.03.07.
Open DOI Search in Google Scholar Back to article
Kim SH, Lee JM, Kim JH, Kim KG, Han JK, Lee KH et al.: Appropriateness of a donor liver with respect to macrosteatosis: application of artificial neural networks to US images – initial experience. Radiology 2005; 234: 793–803. doi: 10.1148/radiol.2343040142.
Open DOI Search in Google Scholar Back to article
Sugimoto K, Moriyasu F, Oshiro H, Takeuchi H, Abe M, Yoshimasu Y et al.: The Role of Multiparametric US of the Liver for the Evaluation of Non-Alcoholic Steatohepatitis. Radiology 2020; 296: 532–540. doi: 10.1148/radiol.2020192665.
Open DOI Search in Google Scholar Back to article

Evaluation of hepatic steatosis in obese children and adolescents using immune-inflammatory markers and shear wave elastography

Abstract

Aim

Methods

Results

Conclusions

Paradigm

My account