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No More Biopsys ??
Oct 4, 2002
Howdy-
Wow it would be great NOT to have a biopsy, mine went bad and hurt like hell, and I hate the idea of a needle the size of a small tree entering my liver, with mine not once,twice but three times, yikes I can feel it now, It would be real nice if they could come up with a realistic test that worked.
Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model

October 2002 • Volume 36 • Number 4

Original Articles

Identification of chronic hepatitis C patients without hepatic fibrosis by a simple predictive model
Xavier Forns1 [MEDLINE LOOKUP]
Sergi Ampurdanès1 [MEDLINE LOOKUP]
Josep M. Llovet1 [MEDLINE LOOKUP]
John Aponte2 [MEDLINE LOOKUP]
Llorenç Quintó2 [MEDLINE LOOKUP]
Eva Martínez-Bauer1 [MEDLINE LOOKUP]
Miquel Bruguera1 [MEDLINE LOOKUP]
Jose Maria Sánchez-Tapias1 [MEDLINE LOOKUP]
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Abstract TOP

Liver biopsy is required for staging hepatic fibrosis in patients with chronic hepatitis C, but it is an expensive procedure with occasional complications and poor patient acceptance. This cohort study was designed to assess the accuracy of a noninvasive method aimed to discriminate between patients with and without significant liver fibrosis (stages 2-4 versus 0-1). Clinically relevant variables were analyzed in a cohort of 476 consecutive untreated patients (estimation group, 351 patients; validation group, 125 patients) with chronic hepatitis C who underwent a liver biopsy. Multivariate analysis identified age, gamma glutamyl transpeptidase (GGT), cholesterol, platelet count, and prothrombin time as independent predictors of fibrosis. We constructed a model and a score system combining age, GGT, cholesterol, and platelet count that proved useful to identify patients without significant hepatic fibrosis. The area under the ROC curve was 0.86 for the estimation group and 0.81 for the validation group. Using the best cutoff score (less than 4.2), presence of significant fibrosis (F2 to F4) could be excluded with high accuracy (negative predictive value of 96%) in 125 (36%) of 351 patients. Similarly, it could be excluded with the same certainty in 49 (39%) of the 125 patients of the validation group. Only 2 patients with liver fibrosis stage 2 were incorrectly classified. In conclusion, a combination of easily accessible variables accurately predicts the absence of significant fibrosis and might render liver biopsy unnecessary in more than one third of patients with chronic hepatitis C. (HEPATOLOGY 2002;36:986-992.)

Abbreviations
HCV hepatitis C virus
ALT alanine aminotransferase
AST aspartate aminotransferase
GGT gamma glutamyl transpeptidase
ROC receiver operating characteristic
AUC area under the curve

Publishing and Reprint Information TOP

From the 1Liver Unit, Institut de Malalties Digestives, and the 2Statistics and Epidemiology Unit, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Catalonia, Spain.
Received March 21, 2002.

Accepted July 17, 2002.

Josep M. Llovet has a contract from Programa “Ramon y Cajal” (Ministerio de Ciencia y Tecnología).

Address reprint requests to: Xavier Forns, M.D., Liver Unit, Institut de Malalties Digestives, Villarroel 170, Hospital Clinic, Barcelona 08036, Spain. E-mail: ; fax: (93) 451-5522.

American Association for the Study of Liver Diseases.



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--Get Outdoors-Enjoy Life----Neil





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