title: Noninvasive prediction of fibrosis in C282Y homozygous hemochromatosis.
abstract: OBJECTIVE
  The diagnosis of hemochromatosis is now possible for C282Y homozygous patients using noninvasive molecular genetic tests. The aim of this study was to define noninvasive factors predictive of severe fibrosis (bridging fibrosis or cirrhosis) to avoid unnecessary liver biopsies in such patients.
  
  
  METHODS
  Clinical and biological data were recorded at the time of diagnosis in 197 French C282Y homozygous patients, 52 (26%) of whom had severe fibrosis. Variables significantly linked to severe fibrosis using univariate analysis were entered into a multivariate stepwise analysis. These variables were combined to obtain a simple index allowing for prediction of severe fibrosis.
  
  
  RESULTS
  Serum ferritin, hepatomegaly, and serum aspartate aminotransferase were selected using multivariate analysis. Their combination applied to the 96 patients with ferritin level of </=1000 microgram/L, normal aspartate aminotransferase values, and absence of hepatomegaly showed that no severe fibrosis was encountered in this subgroup of patients. The results were validated in 113 C282Y homozygous patients in Canada with a good reproducibility of negative prediction but a poor reproducibility of the positive prediction of severe fibrosis.
  
  
  CONCLUSIONS
  In C282Y homozygous patients, the diagnosis of severe fibrosis relies on liver biopsy, but absence of severe fibrosis can be accurately predicted in most patients on the basis of simple clinical and biochemical variables.
authors.affiliation: Clinique des Maladies du Foie and INSERM Unité 49, Rennes, France. Dominique.Guyader@univ-rennes1.fr
authors.forename: D
authors.initials: D
authors.lastname: Guyader
authors.forename: C
authors.initials: C
authors.lastname: Jacquelinet
authors.forename: R
authors.initials: R
authors.lastname: Moirand
authors.forename: B
authors.initials: B
authors.lastname: Turlin
authors.forename: M H
authors.initials: MH
authors.lastname: Mendler
authors.forename: J
authors.initials: J
authors.lastname: Chaperon
authors.forename: V
authors.initials: V
authors.lastname: David
authors.forename: P
authors.initials: P
authors.lastname: Brissot
authors.forename: P
authors.initials: P
authors.lastname: Adams
authors.forename: Y
authors.initials: Y
authors.lastname: Deugnier
mesh_terms: D000328:Adult; D005069:Evaluation Studies as Topic; D005260:Female; D006432:Hemochromatosis / Q000150:complications* / Q000235:genetics*; D006720:Homozygote; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D015999:Multivariate Analysis; D009154:Mutation / Q000502:physiology; D011379:Prognosis