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Fibrotest vs. Biopsy

May 2, 2005

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While primarily about Hyperlipidemia, this article verifies that FibroTest has been validated in chronic Hepatitis c. So, why are doctors still using biopsies???

Screening for Fibrosis with Non-invasive Biomarkers (Fibrotest) in Hyperlipidemic Patients

Insulin resistance is a cause of liver disease that can lead to cirrhosis. Hyperlipidemic patients (HP) have multiple insulin resistance factors and frequent abnormal liver function tests. HP should be screened for significant liver fibrosis (bridging fibrosis: early F2, advanced F3, cirrhosis F4) but biopsy is inappropriate because of the high number of patients at risk.

The aim of the current study was to use FibroTest, validated in chronic hepatitis C, B, alcoholic and non-alcoholic steatosis, to identify HP with F2F3F4.

A consecutive cohort of HP, HCV-HBVneg, <50g alcohol/day, followed in a lipid center was analyzed. Fibrotest was retrospectively performed on frozen fasting sera (–80 C); a control group of blood donors was prospectively included. Fibrotest was performed blinded with security algorithms to identify high-risk of false negative/positive.

Results

Among 1,542 subjects, 40 (2.59%) were excluded using security algorithms, and 1,502 included: 50.3% female, median age 49yrs, 957 HP and 545 controls.

Among HP, 83.4% had cholesterol >=200mg/dl, 93.6% LDL-C >=100mg/dl, 17.5% triglycerides >=200mg/dl, 35.9% BMI >=27, 33% arterial hypertension, 31.8% insulinemia >=10mUI/ml and 13.7% glucose >=6mmol/L.

GGT or ALT were elevated (>=50 IU/L) in 215 HP (22.5%).

F2F3F4 were identified by Fibrotest in 25/957 (2.6%) HP, including 13 F2, 8 F3 and 4 F4 but in none (0%) of the 545 controls (P<0.0001).

Among 25 HP with fibrosis, 19 had normal ALT, 14 normal GGT, 12 normal ALT and GGT, 4 elevated ALT and GGT and 9 elevated ALT or GGT.

Factors associated (p<0.01) with fibrosis were higher age, BMI, triglycerides, uricemia, and insulinemia. In multivariate logistic regression, including alcohol consumption, insulinemia (P=0.003) and triglycerides (P=0.008) were the most significant risk factors.

In HP with triglycerides >=200 mg/dl prevalence of fibrosis was 8.3% and 6.6% with insulinemia >=10mUI/ml.

Conclusions

Based on these results, the authors conclude, “Screening strategies for liver fibrosis are feasible with biomarkers in high-risk groups such as HP.”

“Without such non-invasive strategies a liver biopsy would have been indicated in up to 22.5% of HP with elevated GGT or ALT and would have probably missed half of HP with fibrosis, who had normal GGT and ALT.”

Biopredictive Department, Metabolism Unit, Biochemistry Department, Transfusion Unit, and Hepato-Gastroenterology Department,GHPS, Paris, France.

05/02/05

Reference
M Munteanu and others. SCREENING FOR SIGNIFICANT FIBROSIS USING NON-INVASIVE BIOMARKERS (FIBROTEST) IN HYPERLIPIDEMIC PATIENTS (HP). Abstract 689. 40th EASL. April 13-17, 2005. Paris, France.

Posted by Ralph at May 2, 2005 8:44 AM

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