Document Type
Journal Article
Publication Title
Mayo Clinic Proceedings
Volume
97
Issue
9
First Page
1649
Last Page
1655
PubMed ID
35422339
Publisher
Elsevier
School
School of Medical and Health Sciences
RAS ID
44281
Funders
National Health and Medical Research Council
Grant Number
NHMRC Numbers : APP1048740, APP1061332
Grant Link
http://purl.org/au-research/grants/nhmrc/1048740 http://purl.org/au-research/grants/nhmrc/1061332
Abstract
Objective: To evaluate whether arthritis predicts the likelihood of advanced hepatic fibrosis in HFE hemochromatosis. Patients and Methods: We conducted a retrospective, cross-sectional analysis of 112 well-characterized patients with HFE hemochromatosis and liver biopsy–validated fibrosis staging recruited between January 1, 1983, and December 31, 2013. Complete clinical, biochemical, hematologic, and noninvasive serum biochemical indices (aspartate aminotransferase to platelet ratio index [APRI] and fibrosis 4 index [FIB4]) were available. Scheuer fibrosis stages 3 and 4, APRI greater than 0.44, or FIB4 greater than 1.1 were used to define advanced hepatic fibrosis. Comparisons between groups were performed using categorical analysis, unpaired or paired t test. Results: Male (n = 76) and female (n=36) patients were similar in age. Nineteen patients had advanced hepatic fibrosis, and 47 had hemochromatosis arthritis. Arthritis was significantly associated with the presence of advanced hepatic fibrosis as determined by liver biopsy (sensitivity, 84 %, [95 % CI, 62 % to 95 %]; negative predictive value, 95 % [95 % CI, 87 % to 99 %]; relative risk, 7.4 [95 % CI, 2.5 to 23]; P <. 001), APRI (sensitivity, 75 % [95 % CI, 55 % to 88 %]; negative predictive value, 91 % [95 % CI, 81 % to 96 %]; relative risk, 4.5 [95 % CI, 2.0 to 10.2]; P <. 001), or FIB4 (sensitivity, 61 % [95 % CI, 41 % to 78 %]; negative predictive value, 67 % [95 % CI, 68 % to 90 %]; relative risk, 2.2 [95 % CI, 1.1 to 4.6]; P =. 03). Mean cell volume values were significantly higher pretreatment in patients with F3 - 4 fibrosis (96.7 ± 1.1 fL) compared with F0 - 2 fibrosis (93.4 ± 0.5 fL; P =. 004) and declined following treatment (F3 - 4, 93.2± 0.9 fL, P =. 01; F0 - 2, 91.7 ± 0.6 fL, P =. 01). Conclusion: Advanced hepatic fibrosis is strongly associated with arthritis in HFE hemochromatosis. The absence of arthritis predicts a low likelihood of advanced hepatic fibrosis, supporting its use as a clinical marker for advanced hepatic fibrosis in HFE hemochromatosis.
DOI
10.1016/j.mayocp.2022.02.017
Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.
Comments
This is an Authors Accepted Manuscript version of an article published by ELSEVIER in Mayo Clinic Proceedings. https://doi.org/10.1016/j.mayocp.2022.02.017
Andersson, L., Powell, L. W., Ramm, L. E., Ramm, G. A., & Olynyk, J. K. (2022). Arthritis prediction of advanced hepatic fibrosis in HFE hemochromatosis. Mayo Clinic Proceedings, 97(9), 1649-1655. https://doi.org/10.1016/j.mayocp.2022.02.017