[Utility of various non-invasive methods for fibrosis prediction among Basque Country patients with phenotypic hemochromatosis].
OBJECTIVE
To determine whether the product of multiplying age by liver iron concentration (LIC) (fibrosis index; cut-off, 480,000), platelets, transaminases, and ferritin values are related to the risk of high grade fibrosis.


METHODS
A retrospective study of 32 patients with hereditary hemochromatosis (HH) with phenotypic expression. All patients had a liver biopsy with LIC.


RESULTS
In 7 patients a magnetic resonance imaging (MRI) scan (1.5 T) was obtained with LIC following Alustiza's protocol. Liver biopsy: fibrosis grade (F) 0-2 in 23 patients; F 3-4 in 9. Fibrosis index (FI) showed a specificity of 68%, sensitivity of 85.7%, positive predictive value (PPV) of 42.8%, and negative predictive value (NPV) of 94.4% for high-grade fibrosis. Platelet count ( < 200,000) revealed a NPV of 94.7% for F3-4. Aspartate transaminase (AST) levels above the upper limit of normal showed a NPV of 94.4%; ferritin levels (> 1,000) a NPV of 75%, and MRI-derived LIC x age (> 480,000) a NPV of 80%. The combination of FI (either by biopsy or MRI) with transaminases, and of platelets with transaminases revealed a NPV of 100%.


CONCLUSIONS
FI > 480,000 and platelets < 200,000 have the highest sensitivity for high-degree fibrosis prediction. A negative result allows to discard significant fibrosis in 94% of cases. MRI allows a good fibrosis prediction.
Castiella
A
A
Servicios de Gastroenterología, Radiología y Anatomía Patológica, Hospitales de Mendaro, Mondragón y Donostia, Osatek Donostia, Gipuzkoa. agustincastiella@yahoo.es
Zapata
E
E
Otazua
P
P
Fernández
J
J
Alustiza
J M
JM
Ugarte
M
M
Legasa
L
L
Galardi
A
A
Ugalde
A
A
Barredo
I
I
Arriola
J A
JA
D000328:Adult; D000368:Aged; D001219:Aspartate Aminotransferases / Q000097:blood; D001706:Biopsy; D005260:Female; D005293:Ferritins / Q000097:blood; D006432:Hemochromatosis / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000378:metabolism / Q000473:pathology; D006801:Humans; D007501:Iron / Q000032:analysis / Q000378:metabolism; D019190:Iron Overload; D008099:Liver / Q000737:chemistry / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013030:Spain
D005293:Ferritins; D007501:Iron; D001219:Aspartate Aminotransferases