Z Gastroenterol 2019; 57(05): e161
DOI: 10.1055/s-0039-1691932
POSTER
Hepatologie
Georg Thieme Verlag KG Stuttgart · New York

Diagnostic and prognostic accuracy of fibroscan and FIB-4 in hyperferritinemia and hemochromatosis

A Viveiros
1   Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
,
B Schäfer
1   Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
,
A Finkenstedt
1   Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
,
H Tilg
1   Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
,
H Tilg
1   Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
› Author Affiliations
Further Information

Publication History

Publication Date:
16 May 2019 (online)

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Background:

Ferritin is a surrogate of iron overload but also an indicator of inflammation and liver fibrosis. Non-invasive assessment of fibrosis is important for the prognosis of chronic liver disorders and different ferritin thresholds have been proposed for hemochromatosis, NAFLD and chronic hepatitis C. The aim of the present study was to determine the prevalence of hyperferritinemia and hepatic fibrosis in a large unselected cohort of patients with liver diseases of various etiologies.

Methods:

Between 2000 and 2016 a total of 3362 patients were genotyped for the common hemochromatosis-associated gene polymorphisms (p.Cys282Tyr and p.His63Asp in HFE). Clinical and biochemical parameters and if available transient elastography were assessed at the time of genotyping and the non-invasive fibrosis score FIB-4 was calculated.

Results:

Hyperferritinemia was present in 2061 (61.3%) patients. Fibroscan and FIB-4 showed a significant overall correlation (r = 0.37, p < 0.001). The prevalence of advanced fibrosis as indicated by elastography > 13kPa was 3% in hemochromatosis patients 4% in compound heterozygotes and 22% in patients homozygous of p.His63Asp. Single heterozygous patients and patients without HFE mutations had the highest prevalence of advanced fibrosis with 27.7%. These findings were confirmed when advanced fibrosis was defined as FIB-4 > 3.25. Patients homozygous for p.Cys282Tyr had a prevalence of advanced fibrosis (FIB-4 > 3.25) of 8.6%, followed by compound heterozygous patients (11.9%) and patients homozygous for p.His63Asp (15.4%). Binary logistic regression analysis showed that age, ferritin, transferrin saturation and HFE genotype were independent predictors of significant and advanced fibrosis.

Conclusion:

In hemochromatosis, FIB-4 is a surrogate marker of significant and advanced fibrosis. Among patients with high ferritin, carriers of hemochromatosis-associated HFE mutations on both alleles are less likely to present with advanced fibrosis when compared with patients with high ferritin secondary to chronic viral hepatitis, alcoholic or non-alcoholic fatty liver disease.