Elevated LECT2 and PEDF in Pediatric MAFLD: Diagnostic Performance and Metabolic Correlations.

Purpose: To evaluate the diagnostic value of serum hepatokines, leucocyte cell-derived chemotaxin 2 (LECT2) and pigment epithelium-derived factor (PEDF), for pediatric metabolic-associated fatty liver disease (MAFLD), and to assess their correlations with metabolic/liver injury indices and diagnostic utility. Patients and methods: A total of 198 patients were included in the study (78 in the MAFLD group, 60 in the obese non-MAFLD and 60 in the control group). Serum LECT2 and PEDF levels were measured in all three groups. Group comparisons were performed, and LECT2/PEDF levels were correlated with metabolic parameters, and liver injury markers. ROC curve analyses and logistic regression were also conducted. Results: Serum LECT2 and PEDF levels exhibited stepwise elevations (control < obese non-MAFLD < MAFLD; both P < 0.001), with significant correlations in MAFLD patients to BMI, insulin resistance (HOMA-IR), and liver injury markers (ALT/AST). For MAFLD versus controls, PEDF showed superior diagnostic accuracy (AUC = 0.804, 95% CI: 0.731-0.877) to LECT2 (AUC = 0.734, 0.651-0.817), while combined PEDF with LECT2 further improved discrimination (AUC = 0.849; sensitivity 79.5%, specificity 78.3%). For MAFLD versus obese non-MAFLD, both hepatokines had modest utility (LECT2 AUC = 0.623; PEDF AUC = 0.668), though their combination enhanced performance (AUC = 0.712; sensitivity 60.3%, specificity 73.9%). Multivariable analysis confirmed LECT2 and PEDF as independent MAFLD predictors. Conclusion: LECT2 and PEDF are elevated in pediatric MAFLD and correlate with metabolic dysfunction. While their combination effectively distinguishes MAFLD from healthy controls, it shows moderate efficacy in differentiating MAFLD from simple obesity. Nevertheless, the LECT2/PEDF panel represents a promising risk-stratification tool to identify high-risk obese children for further diagnostic evaluation.