ABSTRACT
BACKGROUND: Severe obesity and metabolic syndrome have been implicated in the development of nonalcoholic fatty liver disease (NAFLD). We evaluated the diagnostic value of liver stiffness measurement (LSM), by transient elastography (FibroScan®) in bariatric surgery candidates with suspected NAFLD. METHODS: A total of 100 prospectively included consecutive severely obese subjects underwent bariatric surgery with liver needle biopsy. LSM was performed in the 15 days preceding liver biopsy. RESULTS: According to Kleiner's classification, 28 patients had no fibrosis, 50 had stage F1 fibrosis, 13 had stage F2 fibrosis, and nine had stage F3 fibrosis. LSMs were higher in patients with fibrosis stage F ≥2, than in patients with a fibrosis stage below F2 (p < 0.001). Fibrosis stage (p < 0.002), amount of steatosis (%) (p < 0.001), BMI (p < 0.02), and activity score (p = 0.027) were independently correlated with LSM. Homeostasis model assessment (HOMA) index was also significantly and independently correlated with LSM (p < 0.01). The area under the receiver operating characteristic curve (AUROC) generated by FibroScan® was 0.81 ± 0.05 for predicting fibrosis stage F ≥2 and 0.85 ± 0.04 for predicting F3 fibrosis. The decrease in LSM 1 year after bariatric surgery was significantly correlated with changes in HOMA index (r = 0.43, p = 0.01), but not with changes in BMI or weight. CONCLUSION: FibroScan® allows the early diagnosis of fibrosis in severely obese patients. Our results also suggest that FibroScan® could identify a subgroup of NAFLD patients at high risk of progressive liver disease and that LSM could be used as a surrogate marker of insulin resistance. Further studies are required to evaluate the prognostic value of FibroScan®.
Subject(s)
Bariatric Surgery , Elasticity Imaging Techniques , Liver Cirrhosis/pathology , Non-alcoholic Fatty Liver Disease/diagnosis , Obesity, Morbid/surgery , Adult , Biopsy , Body Mass Index , Female , Humans , Liver Cirrhosis/complications , Male , Middle Aged , Non-alcoholic Fatty Liver Disease/complications , Obesity, Morbid/complications , Predictive Value of Tests , ROC CurveABSTRACT
BACKGROUND AND AIMS: The PGAA index was one of the first composite liver fibrosis markers. This study aims, prospectively, to confirm the diagnostic value of PGAA and Fibrotest in patients with alcoholic liver disease and to compare their diagnostic performances. PATIENTS AND METHODS: We prospectively included 200 consecutive patients (159 men and 41 women; mean age: 51±0.7 years).The PGAA index was calculated by combining the results of four laboratory tests (prothrombin time, γ-glutamyl transpeptidase, apolipoprotein A1, and α-2-macroglobulin) scored on a 0-4 scale. The Fibrotest score was computed using the Biopredictive website. The overall diagnostic performances of scores were evaluated in terms of the area under the receiver operating characteristic (AUROC) curve. The Obuchowski measure was assessed taking into account the distribution of fibrosis stages observed in the cohort. RESULTS: For predicting F≥2 fibrosis stage, the AUROC curves of PGAA and Fibrotest were 0.83±0.03 and 0.80±0.03, respectively. For predicting F4 fibrosis stage, the AUROC curves of PGAA and Fibrotest were 0.87±0.03 and 0.86±0.03. There was no difference between the AUROC curves of PGAA and Fibrotest. The Obuchowski measure was 0.92±0.01 for PGAA and Fibrotest. For a value of 10, PGAA had 98% specificity and 97% positive predictive value for the detection of F≥2 fibrosis stage and 80% sensitivity and 92% negative predictive value for F4 stage fibrosis. CONCLUSION: We confirm the comparable diagnostic values of Fibrotest and PGAA. When Fibrotest use is constrained by an increase in unconjugated bilirubin or is not financially viable, PGAA may be an alternative.
Subject(s)
Biomarkers/blood , Liver Cirrhosis, Alcoholic/diagnosis , Liver , Prothrombin Time , Algorithms , Apolipoprotein A-I/blood , Area Under Curve , Biopsy , Female , Humans , Liver/metabolism , Liver/pathology , Liver Cirrhosis, Alcoholic/blood , Liver Cirrhosis, Alcoholic/pathology , Male , Middle Aged , Predictive Value of Tests , Prognosis , Prospective Studies , ROC Curve , Severity of Illness Index , alpha-Macroglobulins/analysis , gamma-Glutamyltransferase/bloodABSTRACT
Hepatitis E virus is a major cause of acute viral hepatitis. The diagnosis of acute viral hepatitis E is based essentially on antibodies and hepatitis E virus RNA. We describe herein a case of acute hepatitis E associated with a false-positive serology for Epstein-Barr virus (EBV). This case report suggests that anti-viral capsid antigen IgM must be interpreted with caution in acute E hepatitis. When positive, EBV RNA polymerase chain reaction can be useful as a false positivity of anti-viral capsid antigen IgM and can be misinterpreted as an acute infection. EBV false positivity was probably related to polyclonal stimulation of the immune system, favoured by hepatitis E.
