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Non invasive markers of liver fibrosis

Non invasive markers of liver fibrosis. Fibrotest and ELF By Taher ELZANATY, MD. Population at risk of liver fibrosis , cirrhosis and hepatocellular carcinoma (Millions). Only 5% of patients at risk of fibrosis do have a liver biopsy.

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Non invasive markers of liver fibrosis

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  1. Non invasive markers of liver fibrosis Fibrotest and ELF By Taher ELZANATY, MD

  2. Population at risk of liverfibrosis, cirrhosis and hepatocellularcarcinoma (Millions)

  3. Only 5% of patients atrisk of fibrosis do have a liverbiopsy

  4. Ideal Non-INVASIVE test to assess Hepatic Fibrosis: • Simple. • Widely available. • Inexpensive. • Reproducible. • Accurate prediction of full spectrum of disease severity. • Sensitive to treatment effects. • Track disease progression over time.

  5. Liver Injury Alpha2Macroglobulin Total Bilirubin Gamma GT Apolipoprotein A1 Haptoglobin In Situ In Serum: FibroTest Fibrotic Matrix Activated Stellate Cells Imbert-Bismut, Lancet 2001

  6. SERUM MARKERS PANELS: European Liver Fibrosis ( ELF ) score: - Hyaluronic acid, TIMP-1, PIII NP, age. Fibrotest: - alpha-2 macroglobulins, APOA, Haptoglobin , bilirubin , GGTP, age.

  7. In practice for Ft: • With a physician’s prescription, the patient has a blood sample taken at a biomedical laboratory. • Biologists enter the data directly online ( www.biopredictive.com) to biopredictive company in France where the equation for fibrotest done and get the result’s report within 24 hours.

  8. Serum Markers and HCV Fibrosis ( Sebastani J Viral Hep 2012 ) AUROC ( area under receive operating curve )

  9. Impact of HCV Treatment on FibroTest 1.00 F METAVIR difference -3 -2 0.75 -1 0 1 2 0.50 3 Fibrotest 0.25 0.00 Baseline Follow-up Poynard, Hepatology, 2003

  10. Kinetics of fibrosis according to baseline stages In HBV patients treated with lamivudine 2 years FibroTest-FibroSURE 0.73 1.00 0.52 F2F3F4 P=0.01 0.75 0.50 F0F1 NS 0.25 0.00 6 mo 12 mo 24 mo Baseline 44 Cirrhosis: 42 (95%) improvement at 24 months Significant regression (>0.30) in 14/44 (32%) Poynard et al Am J G 2005

  11. FT • For assessing fibrosis in HCV and HBV • In NAFLD , modified NASH test, we add height, weight, Triglycerides, Cholesterol, AST , ALT. • In HCV, HBV: • cut off 0-0.1……100% NPV for absence for fibrosis. cut off 0.7-1……> 90% PPV for significant fibrosis. cut off between 0.11-0.59 …… intermediate zone, needs another modality to evaluate degree of fibrosis.

  12. FibroTest ,mostfrequent causes of error • False positives • HighBILIRUBIN (Gilbert, hemolysis, extrahepaticcholestasis) • ACUTE HEPATITIS (elevationof ALAT, bilirubin, haptoglobin) • LOW HAPTOGLOBIN:hemolysis

  13. FibroTest ,mostfrequent causes of error • False negatives • High HAPTOGLOBIN : sepsis, inflammation

  14. Conclusions: • FT and ELF are simple non-invasive tests to assess hepatic fibrosis. • FT is useful in identifying only patients with insignificant or advanced degrees of fibrosis. It is not useful in assessing intermediate grades of fibrosis. • FT is not accurate in cases of NAFLD and has a modified test. • ELF Score is suitable only in cases of NASH.

  15. THANK YOU

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