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Poynard T, Deckmyn O, Rudler M, Peta V, Ngo Y, Vautier M, Akhavan S, Calvez V, Franc C, Castille JM, Drane F, Sakka M, Bonnefont-Rousselot D, Lacorte JM, Saadoun D, Allenbach Y, Benveniste O, Gandjbakhch F, Mayaux J, Lucidarme O, Fautrel B, Ratziu V, Housset C, Thabut D, Cacoub P. Performance of serum apolipoprotein-A1 as a sentinel of Covid-19. PLoS One 2020; 15:e0242306. [PMID: 33216772 PMCID: PMC7679025 DOI: 10.1371/journal.pone.0242306] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/31/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Since 1920, a decrease in serum cholesterol has been identified as a marker of severe pneumonia. We have assessed the performance of serum apolipoprotein-A1, the main transporter of HDL-cholesterol, to identify the early spread of coronavirus disease 2019 (Covid-19) in the general population and its diagnostic performance for the Covid-19. METHODS We compared the daily mean serum apolipoprotein-A1 during the first 34 weeks of 2020 in a population that is routinely followed for a risk of liver fibrosis risk in the USA (212,297 serum) and in France (20,652 serum) in relation to a local increase in confirmed cases, and in comparison to the same period in 2019 (266,976 and 28,452 serum, respectively). We prospectively assessed the sensitivity of this marker in an observational study of 136 consecutive hospitalized cases and retrospectively evaluated its specificity in 7,481 controls representing the general population. RESULTS The mean serum apolipoprotein-A1 levels in the survey populations began decreasing in January 2020, compared to the same period in 2019. This decrease was highly correlated with the daily increase in confirmed Covid-19 cases in the following 34 weeks, both in France and USA, including the June and mid-July recovery periods in France. Apolipoprotein-A1 at the 1.25 g/L cutoff had a sensitivity of 90.6% (95%CI84.2-95.1) and a specificity of 96.1% (95.7-96.6%) for the diagnosis of Covid-19. The area under the characteristics curve was 0.978 (0.957-0.988), and outperformed haptoglobin and liver function tests. The adjusted risk ratio of apolipoprotein-A1 for survival without transfer to intensive care unit was 5.61 (95%CI 1.02-31.0; P = 0.04). CONCLUSION Apolipoprotein-A1 could be a sentinel of the pandemic in existing routine surveillance of the general population. NCT01927133, CER-2020-14.
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Affiliation(s)
- Thierry Poynard
- Institute of Cardiometabolism and Nutrition (ICAN), Centre de Recherche Saint-Antoine (CRSA), INSERM, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- * E-mail:
| | | | - Marika Rudler
- Department of Hepatology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | | | - Yen Ngo
- BioPredictive, Research, Paris, France
| | - Mathieu Vautier
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Sepideh Akhavan
- Department of Virology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Vincent Calvez
- Department of Metabolic Biochemistry, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | | | | | | | - Mehdi Sakka
- Department of Metabolic Biochemistry, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | | | - Jean Marc Lacorte
- Department of Biochemistry, Endocrinology and Oncology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - David Saadoun
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Yves Allenbach
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Olivier Benveniste
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | | | - Julien Mayaux
- Department of Intensive Care, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Olivier Lucidarme
- Department of Radiology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Bruno Fautrel
- Department of Rhumatology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Vlad Ratziu
- Department of Hepatology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
- Institut of Cardiometabolism and Nutrition ICAN, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
- INSERM, Sorbonne University, UMRS 1269 Nutriomique, service de Nutrition, APHP, Paris, France
| | - Chantal Housset
- Institute of Cardiometabolism and Nutrition (ICAN), Centre de Recherche Saint-Antoine (CRSA), INSERM, Sorbonne Université, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Dominique Thabut
- Department of Hepatology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Sorbonne Université, AP-HP Pitié-Salpêtrière, Paris, France
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Shen SL, Wang W, Fu SJ, Peng BG. Reply to: Importance of Platelet Indices in Hepatocellular Carcinoma Prognosis. Ann Surg Oncol 2017; 24:653-654. [PMID: 29124489 DOI: 10.1245/s10434-017-6229-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Shun-Li Shen
- Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Wei Wang
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Shun-Jun Fu
- Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China
| | - Bao-Gang Peng
- Department of Liver Surgery, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, People's Republic of China.
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Latent Class Analysis of Noninvasive Methods and Liver Biopsy in Chronic Hepatitis C: An Approach without a Gold Standard. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8252980. [PMID: 29057268 PMCID: PMC5615978 DOI: 10.1155/2017/8252980] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/30/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022]
Abstract
Aims To evaluate the applicability of the Latent Class Analysis (LCA) and accuracy of transient elastography (TE), aspartate-to-platelet-ratio-index (APRI), enhanced liver fibrosis (ELF), and liver biopsy (LB) for liver fibrosis assessment in a model without a gold standard. Methods Significant fibrosis was defined as TE ≥ 7.1 kPa, APRI ≥ 1.5, ELF ≥ 9.37, or LB METAVIR F ≥ 2. Cirrhosis was defined as TE ≥ 12.5 kPa, APRI ≥ 2.0, ELF ≥ 10.31, or LB as METAVIR F = 4. Results 117 patients with chronic hepatitis C were included. In the LCA, for significant fibrosis the sensitivities and specificities (95% CI) were 0.92 (0.86–0.98) and 0.79 (0.72–0.86) for TE; 0.47 (0.40–0.54) and 0.99 (0.95–1.00) for APRI; 0.81 (0.74–0.88) and 0.78 (0.71–0.85) for ELF; and 0.86 (0.68–1.00) and 0.91 (0.79–1.00) for LB. For cirrhosis, the sensitivities and specificities were 0.92 (0.76–1.00) and 0.94 (0.91–0.97) for TE; 0.57 (0.37–0.77) and 0.97 (0.93–1.00) for APRI; 0.94 (0.84–1.00) and 0.88 (0.82–0.94) for ELF; and 0.30 (0.12–0.48) and 1.00 for LB. Conclusion LCA was useful to evaluate accuracy of methods for liver fibrosis staging. Sensitivities and specificities of noninvasive methods were increased in LCA compared to the use of LB as the gold standard.
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Houot M, Ngo Y, Munteanu M, Marque S, Poynard T. Systematic review with meta-analysis: direct comparisons of biomarkers for the diagnosis of fibrosis in chronic hepatitis C and B. Aliment Pharmacol Ther 2016; 43:16-29. [PMID: 26516104 PMCID: PMC4737301 DOI: 10.1111/apt.13446] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 08/05/2015] [Accepted: 10/05/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Blood tests and transient elastography (TE), proposed as alternatives to biopsy for identifying advanced fibrosis (METAVIR-stage-F2 or greater) or cirrhosis, have never been compared using an intention to diagnose approach, with direct comparisons only, and Bayesian approach. AIM To permit more appropriate comparisons. METHODS From an overview of articles (2002-2014), we selected studies that directly compared the diagnostic accuracy of FibroTest, aspartate aminotransferase-platelet ratio index (APRI), FIB4 or TE, with biopsy as a reference, in patients with chronic hepatitis C (CHC) or B (CHB). Investigators abstracted and checked study details and quality by using pre-defined criteria. Bayesian method in intention to diagnose was the primary outcome. RESULTS Of 1321 articles identified, 71 studies including 77 groups according to aetiology (All-CB) were eligible: 37 Only-C, 28 Only-B and 12 Mixed-C-B. There were 185 direct comparisons between the area under the ROC curves (AUROCs), 99 for the diagnosis of advanced fibrosis and 86 for cirrhosis. In All-CB, Bayesian analyses revealed significant AUROCs differences in identifying advanced fibrosis in favour of FibroTest vs. TE [credibility interval: 0.06(0.02-0.09)], FibroTest vs. APRI [0.05 (0.03-0.07)] and for identifying cirrhosis TE vs. APRI [0.07 (0.02-0.13)] and FIB4 vs. APRI [0.04(0.02-0.05)]. No differences were observed between TE and FibroTest, for identifying cirrhosis in All-CB, and in sub-groups (Only-C, Only-B, Mixed-CB) for both cirrhosis and fibrosis. CONCLUSIONS In CHC and CHB, APRI had lower performances than FIB-4, TE and FibroTest. TE had lower performance than FibroTest for identifying advanced fibrosis in All-CB, without significant difference for identifying cirrhosis in all groups.
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Affiliation(s)
| | | | | | | | - T. Poynard
- Hepatology DepartmentAssistance Publique‐Hôpitaux de ParisHôpital Pitié‐SalpêtrièreParisFrance,INSERM & Université Pierre et Marie Curie ‐ Univ Paris 06UMR_S 938Centre de Recherche Saint‐Antoine & Institute of Cardiometabolism and Nutrition (ICAN)ParisFrance
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Automatic detection of cirrhosis in hospitalized patients: a pragmatic experience. Eur J Gastroenterol Hepatol 2016; 28:74-81. [PMID: 26317562 DOI: 10.1097/meg.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND/AIM We evaluated the relevance of a systematic automatic detection of cirrhosis using biochemical markers in hospitalized patients. METHODS We automatically calculated three free biochemical tests (APRI, Fib-4, and Forns) in patients consecutively hospitalized in our university hospital between July and September, 2010. Patients >18 years not known to suffer from chronic liver disease, were contacted to undergo liver stiffness measurement (LSM) as a reference diagnostic tool. To limit false positives, we required at least one APRI≥2 (indicating cirrhosis) and Fib-4>3.25 and/or Forns>6.9, without obvious overestimation. RESULTS A total of 10,035 APRI, 9903 Fib-4, and 1250 Forns were available in 4074 patients. The fibrosis tests were independently influenced by the location of the patient, especially Cardiology (Lower Forns) and Hematology/Oncology Departments (higher APRI, Fib-4, and Forns). Overall, 101 patients (2.48%) were suspected to have cirrhosis. LSM identified two cases of cirrhosis (LSM>13 kPa). In intent-to-diagnose analyses, the highest positive predictive values of the APRI, Fib-4, and Forns for the diagnosis of cirrhosis were 1.98, 1.98, and 11.76%, respectively. The positive predictive value never exceeded 50% in per-protocol analyses when considering patients with numerous positive results of the fibrosis tests. CONCLUSION In hospitalized patients, automatic detection of cirrhosis on the basis of APRI, Fib-4, and Forns was inefficient because of too many false-positive results.
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Castro R, Perazzo H, Grinsztejn B, Veloso VG, Hyde C. Chronic Hepatitis C: An Overview of Evidence on Epidemiology and Management from a Brazilian Perspective. Int J Hepatol 2015; 2015:852968. [PMID: 26693356 PMCID: PMC4677022 DOI: 10.1155/2015/852968] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 11/03/2015] [Accepted: 11/11/2015] [Indexed: 02/06/2023] Open
Abstract
Chronic hepatitis C remains one of the main causes of chronic liver disease worldwide and presents a variable natural history ranging from minimal changes to advanced fibrosis and cirrhosis and its complications, such as development of hepatocellular carcinoma. Approximately, 1.45 million people are estimated to be infected by HCV in Brazil representing a major public health issue. The aim of this paper was to review the epidemiology and management of chronic hepatitis C from a Brazilian perspective. The management of chronic hepatitis C has been challenged by the use of noninvasive methods to stage liver fibrosis as an alternative to liver biopsy and the high cost of new interferon-free antiviral treatments. Moreover, the need of cost-effectiveness analysis in hepatitis C and the recent changes in treatment protocols were discussed.
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Affiliation(s)
- Rodolfo Castro
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil
| | - Hugo Perazzo
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil
| | - Beatriz Grinsztejn
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil
| | - Valdilea G. Veloso
- Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Laboratory of Clinical Research on STD/AIDS, Avenida Brasil 4365, 21040-900 Manguinhos, RJ, Brazil
| | - Chris Hyde
- Institute of Health Research, Peninsula Technology Assessment Group (PenTAG), Evidence Synthesis and Modelling for Health Improvement (ESMI), University of Exeter Medical School, University of Exeter, St Luke's Campus, South Cloisters, Exeter EX1 2LU, UK
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Yang LY, Fu J, Peng XF, Pang SY, Gao KK, Chen ZR, He LJ, Wen Z, Wang H, Li L, Wang FH, Yu JK, Xu Y, Gong ST, Xia HM, Liu HY. Validation of aspartate aminotransferase to platelet ratio for diagnosis of liver fibrosis and prediction of postoperative prognosis in infants with biliary atresia. World J Gastroenterol 2015; 21:5893-5900. [PMID: 26019453 PMCID: PMC4438023 DOI: 10.3748/wjg.v21.i19.5893] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/12/2015] [Accepted: 02/13/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To validate the value of aspartate aminotransferase to platelet ratio index (APRI) in assessment of liver fibrosis and prediction of postoperative prognosis of biliary atresia (BA) infants from Mainland China.
METHODS: Medical records of 153 BA infants who were hospitalized from January 2010 to June 2013 were reviewed. The efficacy of APRI for diagnosis of liver fibrosis was assessed using the receiver operator characteristic (ROC) curve compared to the pathological Metavir fibrosis score of the liver wedge specimens of 91 BA infants. The prognostic value of preoperative APRI for jaundice persistence, liver injury, and occurrence of cholangitis within 6 mo after KP was studied based on the follow-up data of 48 BA infants.
RESULTS: APRI was significantly correlated with Metavir scores (rs = 0.433; P < 0.05). The mean APRI value was 0.76 in no/mild fibrosis group (Metavir score F0-F1), 1.29 in significant fibrosis group (F2-F3), and 2.51 in cirrhosis group (F4) (P < 0.001). The area under the ROC curve (AUC) of APRI for diagnosing significant fibrosis and cirrhosis was 0.75 (P < 0.001) and 0.81 (P = 0.001), respectively. The APRI cut-off of 0.95 was 60.6% sensitive and 76.0% specific for significant fibrosis diagnosis, and a threshold of 1.66 was 70.6% sensitive and 82.7% specific for cirrhosis. The preoperative APRI in infants who maintained jaundice around 6 mo after KP was higher than that in those who did not (1.86 ± 2.13 vs 0.87 ± 0.48, P < 0.05). The AUC of APRI for prediction of postoperative jaundice occurrence was 0.67. A cut-off value of 0.60 showed a sensitivity of 66.7% and a specificity of 83.3% for the prediction of jaundice persistence. Preoperative APRI had no significant association with later liver injury or occurrence of cholangitis.
CONCLUSION: Our study demonstrated that APRI could diagnose significant liver fibrosis, especially cirrhosis in BA infants, and the elevated preoperative APRI predicts jaundice persistence after KP.
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Agilli M, Aydin FN, Cayci T, Kurt YG. Is aspartate aminotransferase-to-platelet ratio index a biomarker in the evaluation of advanced fibrosis in non-alcoholic fatty liver disease? Gastroenterol Rep (Oxf) 2014; 2:323-4. [PMID: 25371481 PMCID: PMC4219149 DOI: 10.1093/gastro/gou063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Affiliation(s)
- Mehmet Agilli
- Department of Biochemistry, Agri Military Hospital, Agri, Turkey, Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey and Department of Medical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - Fevzi Nuri Aydin
- Department of Biochemistry, Agri Military Hospital, Agri, Turkey, Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey and Department of Medical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - Tuncer Cayci
- Department of Biochemistry, Agri Military Hospital, Agri, Turkey, Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey and Department of Medical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
| | - Yasemin Gulcan Kurt
- Department of Biochemistry, Agri Military Hospital, Agri, Turkey, Department of Biochemistry, Sirnak Military Hospital, Sirnak, Turkey and Department of Medical Biochemistry, Gulhane Military Medical Academy, Ankara, Turkey
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Perazzo H, Munteanu M, Ngo Y, Lebray P, Seurat N, Rutka F, Couteau M, Jacqueminet S, Giral P, Monneret D, Imbert-Bismut F, Ratziu V, Hartemann-Huertier A, Housset C, Poynard T. Prognostic value of liver fibrosis and steatosis biomarkers in type-2 diabetes and dyslipidaemia. Aliment Pharmacol Ther 2014; 40:1081-93. [PMID: 25186086 DOI: 10.1111/apt.12946] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 07/09/2014] [Accepted: 08/13/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND In cardiometabolic disorders, non-alcoholic fatty liver disease is frequent and presumably associated with increased mortality and cardiovascular risk. AIM To evaluate the prognostic value of non-invasive biomarkers of liver fibrosis (FibroTest) and steatosis (SteatoTest) in patients with type-2 diabetes and/or dyslipidaemia. METHODS A total of 2312 patients with type-2 diabetes and/or dyslipidaemia were included and prospectively followed up for 5-15 years. The cardiovascular Framingham-risk score was calculated; advanced fibrosis and severe steatosis, were defined by FibroTest >0.48 and SteatoTest >0.69, respectively, as previously established. RESULTS During a median follow-up of 12 years, 172 patients (7.4%) died. The leading causes of mortality were cancer (31%) and cardiovascular-related death (20%). The presence of advanced fibrosis [HR (95% CI)] [2.98 (95% CI 1.78-4.99); P < 0.0001] or severe steatosis [1.86 (1.34-2.58); P = 0.0002] was associated with an increased risk of mortality. In a multivariate Cox model adjusted for confounders: the presence of advanced fibrosis was associated with overall mortality [1.95 (1.12-3.41); P = 0.02]; advanced fibrosis at baseline [n = 50/677; 1.92 (1.04-3.55); P = 0.04] and progression to advanced fibrosis during follow-up [n = 16/127; 4.8 (1.5-14.9); P = 0.007] were predictors of cardiovascular events in patients with type-2 diabetes. In patients with a Framingham-risk score ≥20%, the presence of advanced fibrosis was predictive of cardiovascular events [2.24 (1.16-4.33); P < 0.05]. CONCLUSIONS Liver biomarkers, such as FibroTest and SteatoTest, have prognostic values in patients with metabolic disorders. FibroTest has prognostic value for predicting overall survival in patients with type-2 diabetes and/or dyslipidaemia. In type-2 diabetes, FibroTest predicted cardiovascular events and improved the Framingham-risk score.
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Affiliation(s)
- H Perazzo
- Hepatology Department, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France; Centre de Recherche Saint-Antoine & Institute of Cardiometabolism and Nutrition (ICAN), INSERM & Université Pierre et Marie Curie - Univ Paris 06 UMR_S 938, Paris, France
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