Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital...
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Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital Universitario da Universidade Federal do Rio de Janeiro - Brasil
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Transcript of Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital...
Case Report
Ana Carolina CardosoHôpital Beaujon – Universite Paris VII - FranceHospital Universitario da Universidade Federal do Rio de Janeiro - Brasil
Case Report
Ana Carolina CardosoHôpital Beaujon – Universite Paris VII - FranceHospital Universitario da Universidade Federal do Rio de Janeiro - Brasil
Case Report
57 years old, male
2004: diagnosis of HCV infection
Contamination: unknown
Genotype 3a, Viral Load: 1 200 000 IU/mL
BMI: 28, DM
No excessive alcohol intake and tobacco use
Case Report
Liver biopsy (2005): A1F1 (METAVIR)
Treatment (2005): PEG INF / RBV – NR
Poor tolerance
Follow-up / not retreated
Platelets 170 G/LPlatelets 170 G/L
PT 85 %PT 85 %
ALT 102 IU/lALT 102 IU/l
AST 93 IU/lAST 93 IU/l
GGT 220 IU/LGGT 220 IU/L
BMI: 32BMI: 32
Case Report
• January / 2011January / 2011
Liver Biopsy ?
Case Report
January / 2011January / 2011
FibroScan® – 11.2 kPa
Case Report
January / 2011January / 2011
FibroScan® – 11.2 kPa
FibroScan® – 11.2 kPa / 0.9 / 90%
8.8 9.6 14.6FibroScan® (kPa)
Liver Fibrosis
(METAVIR)
F0-F1 F2 F3 F4
Ziol et al, Hepatology 2005Ziol et al, Hepatology 2005
Case Report
1.1. FibroScanFibroScan® is correct ? is correct ?
2.2. Liver Biopsy ?Liver Biopsy ?
3.3. Another non invasive test ?Another non invasive test ?
Case Report – Question 1
What could we conclude ?
Case Report
January / 2011January / 2011
FibroTest – 0.80
Case Report
January / 2010January / 2010
FibroTest – 0.80
FibrotestFibrotest Equivalent Equivalent METAVIRMETAVIR
0.75-1.000.75-1.00 F4F4
0.73-0.740.73-0.74 F3-F4F3-F4
0.59-0.720.59-0.72 F3F3
0.49-0.580.49-0.58 F2F2
0.32-0.480.32-0.48 F1-F2F1-F2
0.28-0.310.28-0.31 F1F1
0.22-0.270.22-0.27 F0-F1F0-F1
0.00-0.210.00-0.21 F0F0
FibrotestFibrotest Equivalent Equivalent METAVIRMETAVIR
0.75-1.000.75-1.00 F4F4
0.73-0.740.73-0.74 F3-F4F3-F4
0.59-0.720.59-0.72 F3F3
0.49-0.580.49-0.58 F2F2
0.32-0.480.32-0.48 F1-F2F1-F2
0.28-0.310.28-0.31 F1F1
0.22-0.270.22-0.27 F0-F1F0-F1
0.00-0.210.00-0.21 F0F0
Imbert-Bismuth et al. Lancet 2001; 357: 2069-75
Haptoglobin
Alpha-2 macroglobulin
Apolipoprotein A1
Total Bilirubin
Gamma GT
Case ReportCase Report
1.1. FibroScanFibroScan® and Fibrotest 3/6 months later ? and Fibrotest 3/6 months later ?
2.2. Liver biopsy ?Liver biopsy ?
3.3. Start new treatment immediately ?Start new treatment immediately ?
Case Report – Question 2
What should we propose ?
Case Report
• July / 2011July / 2011
Platelets 181 G/LPlatelets 181 G/L
PT 90 %PT 90 %
ALT 133 IU/LALT 133 IU/L
AST 88 IU/LAST 88 IU/L
GGT 130 IU/LGGT 130 IU/L
BMI 30 IU/LBMI 30 IU/L
Case Report
July / 2011July / 2011
FibroScan® – 12.0 kPa / 1.2 / 100%
FibroTest – 0.78
Case Report – Liver Biopsy
PT
CV
Liver fragment – 20 mm and 12 portal tracts
L.B: STEATOHEPATITIS + Hep C Metavir A0F1
FibroTest (n=8524)
False Positives
HemolysisHemolysis
Haptoglobin < 0.30 g/lHaptoglobin < 0.30 g/l
GilbertGilbert
Bilirubin >17 µmol/l
GGT< 30 UI/l
SepsisSepsis
Poynard et al. Clin Chem 2004; 8: 1344-55
False Negatives InflammationInflammation
Haptoglobin > 2.0g/lHaptoglobin > 2.0g/l
Case Report
FibroScan® (n=13 369)
Limitations
Obesity (BMI > 30)Obesity (BMI > 30)
Limited operator experienceLimited operator experience
FemaleFemale
Age > 52 ysAge > 52 ys
DiabetesDiabetes
HypertensionHypertension
Castera et al. Hepatology 2010;51: 828-35
Case Report
STEATOSIS AND LIVER STIFFNESS
> 30%< 30%
20,0
15,0
10,0
5,0
0,0
Liv
er stiffness (kPa) P < 0.001
6.28.5
Cardoso et al [abstract]. Hepatology International 2010
STEATOSIS DETECTION USING CAP
0 0.2 0.4 0.6 0.8 10
0.2
0.4
0.6
0.8
1
1-Sp
Se
5%, AUC = 0.76 (0.72~0.80) 11%, AUC = 0.80 (0.76~0.83) 34%, AUC = 0.86 (0.83~0.90)
Beaugrand et at. JVH 2011Beaugrand et at. JVH 2011
STEATOSIS DETECTION USING CAPSTEATOSIS DETECTION USING CAP
0 0.2 0.4 0.6 0.8 10
0.2
0.4
0.6
0.8
1
1-Sp
Se
S0 vs S123, AUC=0.82 (0.73~0.92)
T = 236 dB/mT = 236 dB/m,, Se=0.83 Se=0.83,, Sp=0.73 Sp=0.73 T = 255 dB/m, Se=0.94, Sp=0.63 T = 255 dB/m, Se=0.94, Sp=0.63
0 0.2 0.4 0.6 0.8 10
0.2
0.4
0.6
0.8
1
1-Sp
Se
S012 vs S3, AUC=0.97 (0.84~1)
T = 282 dB/mT = 282 dB/m,, Se=0.95 Se=0.95,, Sp=1 Sp=1 Cardoso et al, AASLD 2010Cardoso et al, AASLD 2010
0 0.2 0.4 0.6 0.8 10
0.2
0.4
0.6
0.8
1
1-Sp
Se
S01 vs S23, AUC=0.82 (0.69~0.95)
Case ReportTake-Home Messages
FibroScan® and some serum markers are good tools
for non invasive evaluation of liver fibrosis and can
avoid liver biopsy in many cases.
However discordance can occurs in 25%
10% of the discordances do not have an explanation
Liver biopsy persist as the best standart for these
cases
FibrotestFibrotest Equivalent Equivalent METAVIRMETAVIR
0.75-1.000.75-1.00 F4F4
0.73-0.740.73-0.74 F3-F4F3-F4
0.59-0.720.59-0.72 F3F3
0.49-0.580.49-0.58 F2F2
0.32-0.480.32-0.48 F1-F2F1-F2
0.28-0.310.28-0.31 F1F1
0.22-0.270.22-0.27 F0-F1F0-F1
0.00-0.210.00-0.21 F0F0
Imbert-Bismuth et al. Lancet 2001; 357: 2069-75
Haptoglobin
Alpha-2 macroglobulin
Apolipoprotein A1
Total Bilirubin
Gamma GT
Case ReportCase Report
Castera et al, J Hepatol 2008; 48: 835-47
Case Report
10 validated measures
IQR < 30% median
Success rate > 60%11.211.2
0.90.9 14.614.6
