Performance of Blood-Based Indirect Scores Compared to Transient Elastography in Children with Chronic Liver Disease

In this diverse pediatric cohort, simple indirect scores-particularly GPR, APRI, and FibroIndex-demonstrated the highest concordance relative to TE findings, with negative predictive values up to 100% for GPR. This indicates that they can serve as reliable first-line screening tools when TE is unavailable. While their good negative predictive values allow for the confident exclusion of severe disease-potentially sparing many children from invasive testing-their low positive predictive values limit their role in definitive diagnosis. The systematic failure of adult-derived, age-dependent formulas in this cohort underscores the critical need for specialized pediatric biomarkers.