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FT in diagnostic of HBV FibroMax in the most common liver diseases FibroMax: a universal biomarker of liver disease.

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Presentation on theme: "FT in diagnostic of HBV FibroMax in the most common liver diseases FibroMax: a universal biomarker of liver disease."— Presentation transcript:

1 FT in diagnostic of HBV FibroMax in the most common liver diseases FibroMax: a universal biomarker of liver disease

2 FT in diagnostic of HBV 1. What is FibroMax? 2. FibroMax in Viral Hepatitis: FibroTest-ActiTest 3. FibroMax in Steatosis: SteatoTest 4. FibroMax in non alcoholic steato-hepatitis: NashTest 5. FibroMax in alcoholic steato hepatitis: AshTest 6.Meta-analysis In this Presentation

3 FT in diagnostic of HBV 5 tests together to assess liver injuries in HBV, HCV, NAFLD, ALD What is FibroMax? Patient Profile ActiTest FibroTestSteatoTest AshTest NashTest FibroMax For Fibrosis For Viral activity For NASH activity For ASH activity For Steatosis

4 FT in diagnostic of HBV FibroMax in Viral Hepatitis FibroTest-ActiTest presentation

5 FT in diagnostic of HBV ActiTest FibroTestSteatoTest AshTest NashTest FibroMax For Fibrosis For Viral activity For NASH activity For ASH activity For Steatosis

6 FT in diagnostic of HBV FibroMax in viral hepatitis B and C For more information please report to following presentations –FibroTest in the diagnosis of HBV, FibroTest: prognostic value in HBV, FibroTest in the diagnosis of HCV, FibroTest: prognostic value in HCV Presentations available on Relationship between FibroTest and the stage of firbosis and between ActiTest and the grade of Activity

7 FT in diagnostic of HBV FibroMax in Steatosis SteatoTest Presentation

8 FT in diagnostic of HBV ActiTest FibroTestSteatoTest AshTest NashTest FibroMax For Fibrosis For Viral activity For NASH activity For ASH activity For Steatosis

9 FT in diagnostic of HBV Bellentani, Dionysos Study, J Hepatol 2001 Population at risk of liver steatosis (Millions)

10 FT in diagnostic of HBV FibroMax + Age, Gender Haptoglobin Alpha2Macroglobulin Apolipoprotein A1 Total Bilirubin Gamma GT FibroTest Glucose ALT Cholesterol AST Triglycerides + Weight, Height Biomarker activity in steatosis

11 FT in diagnostic of HBV Poynard Comp Hepatol 2005 The diagnostic value of biomarkers (SteatoTest) for the prediction of liver steatosis Included Patients Validation group 1 HCV before treatment N=310 Validation group 2 HCV sustained responders N=201 quasi-normal characteristics with normal liver tests only 11% grade 2–4 steatosis. Validation group 3 Alcoholic liver disease N=62 more often male, older, had smaller liver biopsies, more metabolic risk factors, more extensive fibrosis more grades 2–4 steatosis Control group Healthy blood donors N=140 Patients included in the 4 groups similar in age with predominance of male subjects (range 61–76%). The prevalence of steatosis greater than 5% (grades 2 to 4) varied from 11% in hepatitis C virus (HCV) cured patients to 94% in patients with ALD. In all groups, at least one metabolic risk factor was observed in more than 50% of included patients.

12 FT in diagnostic of HBV SteatoTest versus GGT and ALT Poynard Comp Hepatol 2005 Relationship between ST, GGT and ALT and the grade of liver steatosis in the 3 validation groups Validation group 1 SteatoTestGGTALT Validation group 2 SteatoTestGGTALT Validation group 3 SteatoTestGGTALT

13 FT in diagnostic of HBV SteatoTest versus GGT and ALT Poynard Comp Hepatol 2005 Relationship between ST, GGT and ALT and the grade of liver steatosis in the integrated database combining controls, training group and validation groups AUROC=0.80AUROC=0.66 AUROC=0.61 SteatoTestGGTALT

14 FT in diagnostic of HBV SteatoTestUltraSonographySignificance Kappa0.44 ± ± AUROC0.78 ± ± SteatoTest versus UltraSonography Poynard et al, Comp Hepato 2005 Biopsy as Gold Standard n=304

15 FT in diagnostic of HBV FibroMax in Non Alcoholic Steato-Hepatitis NashTest

16 FT in diagnostic of HBV ActiTest FibroTestSteatoTest AshTest NashTest FibroMax For Fibrosis For Viral activity For NASH activity For ASH activity For Steatosis

17 FT in diagnostic of HBV NashTest: AUROC Poynard et al, BMC Gastro 2006 NashTest for NASH ROC for Kleiner ClassNashTest for NASH 124 validation cases of CYTOL prospective study AUROC NASH = 0.83 (SE=0.04) -- Nash -- Borderline Nash -- No Nash

18 FT in diagnostic of HBV NashTest versus Biopsy - Poynard et al BMC Gastro 2006 Concordance between NASH predicted by NashTest and predicted by biopsy (in all patients n=257) Biopsy NT No Nash Borderline Nash Nash No Nash49118 Borderline Nash Nash3821 Kappa Statistic Discordance 1 class99/257=39% Discordance 2 classes11/257=4%

19 FT in diagnostic of HBV NashTest versus Biopsy - Poynard et al BMC Gastro 2006 Sensitivity, Specificity and predictive values of NashTest for the diagnosis of NASH (in all patients n=257) SensitivitySpecificityPPVNPV No Nash33%94% 66% Prevalence= % Borderline Nash or Nash 88%50% 74% Prevalence= % Conclusion In patients with non-alcoholic fatty liver disease, NashTest, a simple and non-invasive biomarker reliably predicts the presence or absence of NASH. Among patients with NAFLD, the new generation of biomarkers such as FibroTest, SteatoTest and NashTest will allow better identification of those at risk and reassurance for patients without fibrosis or NASH. Biomarkers as a first-line estimate of injury in chronic liver diseases should reduce the need for liver biopsy

20 FT in diagnostic of HBV Proposed screening strategy of advanced fibrosis, steatosis and NASH in NAFLD patients.

21 FT in diagnostic of HBV FibroMax in Alcoholic Steato-Hepatitis AshTest

22 FT in diagnostic of HBV ActiTest FibroTestSteatoTest AshTest NashTest FibroMax For Fibrosis For Viral activity For NASH activity For ASH activity For Steatosis

23 FT in diagnostic of HBV AshTest versus AST/ALT and Maddrey Thabut et al, J Hepatol 2006 Diagnostic values of AshTest, Maddrey and AST/ALT ratio for the diagnosis of alcoholic hepatitis (225 patients 299 controls) AshTest AUROC=0.89AST/ALT AUROC=0.78Maddrey AUROC=0.78

24 FT in diagnostic of HBV AshTest versus AST/ALT and Maddrey Thabut et al, J Hepatol 2006 ROC curves of AshTest, Maddrey and AST/ALT ratio for the diagnosis of alcoholic hepatitis (n=225). Conclusions In heavy drinkers, AshTest is a simple and non-invasive quantitative estimate of alcoholic hepatitis. The use of AshTest may reduce the need for liver biopsy, and therefore allow an earlier treatment of alcoholic hepatitis. AshTest Maddrey AST/ALT

25 FT in diagnostic of HBV Proposed screening strategy of severe alcoholic steatohepatitis (ASH) in excessive drinkers ASH screening and treatment strategy

26 FT in diagnostic of HBV Proposed screening strategy of severe alcoholic steatohepatitis (ASH) in excessive drinkers Fibrosis screening strategy in ALD patient


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