title: Non-invasive assessment of liver fibrosis in C282Y homozygous HFE hemochromatosis.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.|Inserm UMR991, CHU de Rennes, Rennes, France.
authors.forename: Ludivine
authors.initials: L
authors.lastname: Legros
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.|Inserm UMR991, CHU de Rennes, Rennes, France.|University of Rennes 1, CHU de Rennes, Rennes, France.
authors.forename: Edouard
authors.initials: E
authors.lastname: Bardou-Jacquet
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.
authors.forename: Marianne
authors.initials: M
authors.lastname: Latournerie
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Guillygomarc'h
authors.affiliation: University of Rennes 1, CHU de Rennes, Rennes, France.|Department of Pathology, CHU de Rennes, Rennes, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Turlin
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.
authors.forename: Caroline
authors.initials: C
authors.lastname: Le Lan
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.
authors.forename: Yoann
authors.initials: Y
authors.lastname: Désille
authors.affiliation: Clinical Investigation Unit, Inserm CIC0203, CHU de Rennes, Rennes, France.
authors.forename: Fabrice
authors.initials: F
authors.lastname: Lainé
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.|Inserm UMR991, CHU de Rennes, Rennes, France.|University of Rennes 1, CHU de Rennes, Rennes, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Moirand
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.|Inserm UMR991, CHU de Rennes, Rennes, France.|University of Rennes 1, CHU de Rennes, Rennes, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Brissot
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.|University of Rennes 1, CHU de Rennes, Rennes, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Deugnier
authors.affiliation: Liver disease unit and National reference center for rare iron overload diseases of genetic origin, CHU de Rennes, Rennes, France.|University of Rennes 1, CHU de Rennes, Rennes, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Guyader
mesh_terms: D000328:Adult; D001706:Biopsy; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005293:Ferritins / Q000097:blood*; D006432:Hemochromatosis / Q000150:complications* / Q000235:genetics; D006720:Homozygote; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009154:Mutation; D011446:Prospective Studies; D012372:ROC Curve; D000637:Transaminases / Q000097:blood
chemical_list: D006820:Hyaluronic Acid; D005293:Ferritins; D000637:Transaminases
keywords: cirrhosis; hyaluronic acid; liver fibrosis; serum ferritin; transient elastography