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Non-invasive assessment of liver fibrosis in C282Y homozygous HFE hemochromatosis.

Abstract : Background & aims - C282Y homozygotes with serum ferritin (SF) levels >1000 μg/L and/or increased serum transaminase levels are at risk of severe F3/F4 fibrosis. Current practical guidelines recommend liver biopsy in such individuals. This prospective observational cohort study aimed to evaluate non-invasive alternative means such as hyaluronic acid (HA) and transient elastography (TE) for the assessment of severe fibrosis in patients with SF >1000 μg/L or elevated transaminases. Methods - Between September 2005 and April 2013, 77 patients diagnosed C282Y homozygotes underwent a liver biopsy because of SF >1000 μg/L and/or increased transaminases according to current guidelines, with concomitant TE. All of them had clinical and biological evaluation, including HA measurement in 52 cases. Results - A total of 19.5% of patients had F3-F4 severe fibrosis. HA was higher in patients with severe fibrosis, but did not accurately predict severe fibrosis. TE was significantly higher in patients with severe fibrosis (17.2 vs. 4.9 kPa; P < 0.05) and was able to accurately predict fibrosis stage in 47/61 (77%) patients with valid measurement using a lower threshold of 6.4 kPa and an upper threshold of 13.9 kPa. Efficient assessment of severe fibrosis was not possible in patients with intermediate TE values. Conclusion - An algorithm that successively employed SF and TE can accurately classify severe fibrosis in 61% of patients, restricting the need for liver biopsy to the 39% of patients with intermediate or unvalid TE values. This algorithm should be validated in independent cohorts before extended use.
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https://hal-univ-rennes1.archives-ouvertes.fr/hal-01134727
Contributor : Laurent Jonchère <>
Submitted on : Tuesday, March 24, 2015 - 11:12:51 AM
Last modification on : Tuesday, October 20, 2020 - 11:05:35 AM

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Ludivine Legros, Edouard Bardou-Jacquet, Marianne Latournerie, Anne Guillygomarc'H, Bruno Turlin, et al.. Non-invasive assessment of liver fibrosis in C282Y homozygous HFE hemochromatosis.. Liver International, Wiley-Blackwell, 2015, 35 (6), pp.1731-1738. ⟨10.1111/liv.12762⟩. ⟨hal-01134727⟩

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