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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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Presentation on theme: "Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital Universitario da Universidade Federal do Rio de Janeiro - Brasil."— Presentation transcript:

1 Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital Universitario da Universidade Federal do Rio de Janeiro - Brasil Case Report Ana Carolina Cardoso Hôpital Beaujon – Universite Paris VII - France Hospital Universitario da Universidade Federal do Rio de Janeiro - Brasil

2 Case Report 57 years old, male 2004: diagnosis of HCV infection Contamination: unknown Genotype 3a, Viral Load: IU/mL BMI: 28, DM No excessive alcohol intake and tobacco use

3 Case Report Liver biopsy (2005): A1F1 (METAVIR) Treatment (2005): PEG INF / RBV – NR Poor tolerance Follow-up / not retreated

4 Platelets 170 G/L Platelets 170 G/L PT 85 % PT 85 % ALT 102 IU/l ALT 102 IU/l AST 93 IU/l AST 93 IU/l GGT 220 IU/L GGT 220 IU/L BMI: 32 BMI: 32 Case Report January / 2011 January / 2011 Liver Biopsy ?

5 Case Report January / 2011 FibroScan ® – 11.2 kPa

6 Case Report January / 2011 FibroScan ® – 11.2 kPa FibroScan ® – 11.2 kPa / 0.9 / 90%

7 FibroScan ® (kPa) Liver Fibrosis (METAVIR) F0-F1 F2 F3 F4 Ziol et al, Hepatology 2005 Case Report

8 1.FibroScan is correct ? 1.FibroScan ® is correct ? 2.Liver Biopsy ? 3.Another non invasive test ? Case Report – Question 1 What could we conclude ?

9 Case Report January / 2011 FibroTest – 0.80

10 Case Report January / 2010 FibroTest – 0.80 Fibrotest Equivalent METAVIR F F3-F F F F1-F F F0-F F0

11 Fibrotest F F3-F F F F1-F F F0-F F0 Imbert-Bismuth et al. Lancet 2001; 357: Haptoglobin Alpha-2 macroglobulin Apolipoprotein A1 Total Bilirubin Gamma GT Case Report

12 1.FibroScan and Fibrotest 3/6 months later ? 1.FibroScan ® and Fibrotest 3/6 months later ? 2.Liver biopsy ? 3.Start new treatment immediately ? Case Report – Question 2 What should we propose ?

13 Case Report July / 2011 July / 2011 Platelets 181 G/L Platelets 181 G/L PT 90 % PT 90 % ALT 133 IU/L ALT 133 IU/L AST 88 IU/L AST 88 IU/L GGT 130 IU/L GGT 130 IU/L BMI 30 IU/L BMI 30 IU/L

14 Case Report July / 2011 FibroScan ® – 12.0 kPa / 1.2 / 100% FibroTest – 0.78

15 Case Report – Liver Biopsy PT CV Liver fragment – 20 mm and 12 portal tracts L.B: STEATOHEPATITIS + Hep C Metavir A0F1

16 FibroTest (n=8524) False Positives Hemolysis Hemolysis Haptoglobin < 0.30 g/l Haptoglobin < 0.30 g/l Gilbert Gilbert Bilirubin >17 µmol/l GGT< 30 UI/l Sepsis Sepsis Poynard et al. Clin Chem 2004; 8: False Negatives Inflammation Inflammation Haptoglobin > 2.0g/l Haptoglobin > 2.0g/l Case Report

17 FibroScan ® (n=13 369) Limitations Obesity (BMI > 30) Obesity (BMI > 30) Limited operator experience Limited operator experience Female Female Age > 52 ys Age > 52 ys Diabetes Diabetes Hypertension Hypertension Castera et al. Hepatology 2010;51: Case Report

18 STEATOSIS AND LIVER STIFFNESS P < Cardoso et al [abstract]. Hepatology International 2010

19 STEATOSIS DETECTION USING CAP Beaugrand et at. JVH 2011

20 STEATOSIS DETECTION USING CAP T = 236 dB/m, Se=0.83, Sp=0.73 T = 255 dB/m, Se=0.94, Sp=0.63 T = 282 dB/m, Se=0.95, Sp=1 Cardoso et al, AASLD 2010

21 Case Report Take-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

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23 Fibrotest Equivalent METAVIR F F3-F F F F1-F F F0-F F0 Imbert-Bismuth et al. Lancet 2001; 357: Haptoglobin Alpha-2 macroglobulin Apolipoprotein A1 Total Bilirubin Gamma GT Case Report

24 Castera et al, J Hepatol 2008; 48: Case Report 10 validated measures IQR < 30% median Success rate > 60%


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