Jean-Charles Renversez

Comparison of nine blood tests and transient elastography for liver fibrosis in chronic hepatitis C: the ANRS HCEP-23 study.

BACKGROUND & AIMS Blood tests and transient elastography (Fibroscan™) have been developed as alternatives to liver biopsy. This ANRS HCEP-23 study compared the diagnostic accuracy of nine blood tests and transient elastography (Fibroscan™) to assess liver fibrosis, vs. liver biopsy, in untreated patients with chronic hepatitis C (CHC). METHODS This was a multicentre prospective independent study in 19 French University hospitals of consecutive adult patients having simultaneous liver biopsy, biochemical blood tests (performed in a centralized laboratory) and Fibroscan™. Two experienced pathologists independently reviewed the liver biopsies (mean length=25±8.4 mm). Performance was assessed using ROC curves corrected by Obuchowskis method. RESULTS Fibroscan™ was not interpretable in 113 (22%) patients. In the 382 patients having both blood tests and interpretable Fibroscan™, Fibroscan™ performed similarly to the best blood tests for the diagnosis of significant fibrosis and cirrhosis. Obuchowskis measure showed Fibrometer® (0.86), Fibrotest® (0.84), Hepascore® (0.84), and interpretable Fibroscan™ (0.84) to be the most accurate tests. The combination of Fibrotest®, Fibrometer®, or Hepascore® with Fibroscan™ or Apri increases the percentage of well classified patients from 70-73% to 80-83% for significant fibrosis, but for cirrhosis a combination offers no improvement. For the 436 patients having all the blood tests, AUROCs ranged from 0.82 (Fibrometer®) to 0.75 (Hyaluronate) for significant fibrosis, and from 0.89 (Fibrometer® and Hepascore®) to 0.83 (FIB-4) for cirrhosis. CONCLUSIONS Contrarily to blood tests, performance of Fibroscan™ was reduced due to uninterpretable results. Fibrotest®, interpretable Fibroscan™, Fibrometer®, and Hepascore® perform best and similarly for diagnosis of significant fibrosis and cirrhosis.

Serum ferritin, cardiovascular risk factors and ischaemic heart diseases: a prospective analysis in the SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) cohort

BACKGROUND Iron has been suggested to play a role in the development of cardiovascular disease (CVD) through its pro-oxidant properties. However, epidemiological studies on iron status and the risk of CVD have yielded conflicting results. We therefore carried out a prospective study to evaluate the relationship between iron status and CVD in a middle-aged French population. METHODS In total, 9917 subjects (3223 men aged 45-60 years and 6694 women aged 35-60 years) included in the SU.VI.MAX (SUpplementation en VItamines et Minéraux AntioXydants) cohort were followed prospectively for 7.5 years. All cases of ischaemic heart disease (IHD) were identified and validated. CVD risk factors, haemoglobin and serum ferritin concentrations were measured at baseline. FINDINGS Of men 4.3%, and of women 37.8%, presented at baseline a serum ferritin concentration <30 microg l(-1). During the follow-up, 187 subjects (148 men, 39 women) developed IHD. Serum ferritin was positively associated with total cholesterol, serum triglycerides, systolic and diastolic blood pressure, body mass index and haemoglobin. No linear association was found between serum ferritin and IHD risk in men or in women. CONCLUSION Our data do not support a major role of iron status in the development of IHD in a healthy general population.

Independent validation of the Enhanced Liver Fibrosis (ELF) score in the ANRS HC EP 23 Fibrostar cohort of patients with chronic hepatitis C

Abstract Background : The Enhanced Liver Fibrosis (ELF) score combining serum hyaluronan, N-terminal peptide of type III procollagen and tissue inhibitor of metalloproteinase-1, was reported as relevant in predicting liver fibrosis in chronic liver disease and proposed as an alternative to liver biopsy. Methods : We evaluated the ELF score in a cohort of chronic hepatitis C (CHC) patients included in a multicenter prospective study (ANRS HC EP 23 Fibrostar) using commercial reagents, different from those developed by the manufacturer of the Siemens ELF™ test. Results : In 512 CHC, the ELF score, using ROC curves, showed good predictive performances for severe fibrosis [AUROC=0.82; 95% confidence interval (CI) 0.78–0.86]and for cirrhosis (AUROC=0.85; 95% CI 0.81–0.90), but slightly lower for significant fibrosis (AUROC=0.78; 95% CI 0.74–0.82). The Obuchowski measure (0.81) showed that the ELF score globally performed as a marker of liver fibrosis. The ELF score predicted significant fibrosis (cut-off=9.0) with a sensitivity of 0.86, a specificity of 0.62, a positive predictive value (PPV) of 0.80 and a negative predictive value (NPV) of 0.70. For extensive fibrosis (cut-off=9.33), sensitivity was 0.90, specificity was 0.63, PPV was 0.73 and NPV was 0.85. For cirrhosis (cut-off=9.35), sensitivity was 0.83, specificity was 0.75, PPV was 0.44 and NPV was 0.95. Conclusions : This study confirms the ELF score performance as an index to predict liver fibrosis or cirrhosis in CHC. The ELF test, using validated reagents, could be added to the health authorities approved non-invasive tests in assessing fibrosis as surrogate to liver biopsy. a The ANRS HC EP 23 Fibrostar Study Group Sponsor: French National Agency for Research on aids and viral hepatitis (ANRS), Paris. Scientific Committee: Coordinators: J.-P. Zarski, Grenoble; M. Vaubourdolle, Paris; Hepatologists: J.-P. Bronowicki, Lille; P. Calès, Angers; A. Mallat, Créteil; P. Mathurin, Lille; Pathologists: N. Sturm, Grenoble; E.S. Zafrani, Créteil; Biologists: B. Poggi, Lyon; J. Guéchot, Paris; Methodologists and administrators: J.L. Bosson; A. Paris; ANRS: L. Allain, Paris. Methodologists and administrators: A. Bechet, J.-L. Bosson, A. Paris, A. Plages, S. Royannais, Centre Hospitalier Universitaire de Grenoble Biologists: R.-C. Boisson, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon M.-C. Gelineau, B. Poggi, Hôtel Dieu, Hospices Civils de Lyon J.-C. Renversez, C. Trocmé, Centre Hospitalier Universitaire de Grenoble J. Guéchot, E. Lasnier, M. Vaubourdolle, Hôpital Saint-Antoine, AP-HP, Paris H. Voitot, Hôpital Beaujon, AP-HP, Paris A. Vassault, Hôpital Necker, AP-HP, Paris A. Rosenthal-Allieri, Centre Hospitalier Universitaire de Nice A. Lavoinne, F. Ziegler, Centre Hospitalier Universitaire de Rouen M. Bartoli, C. Dorche, C. Lebrun, Centre Hospitalier de Chambéry A. Myara, Growwupe Hospitalier Paris Saint-Joseph, Paris F. Guerber, A. Pottier, Laboratoire Elibio-Groupe Oriade, Vizille, La Mure Hepatologists: V. Leroy, J.-P. Zarski, Centre Hospitalier Universitaire de Grenoble A. Poujol-Robert, R. Poupon, Hôpital Saint-Antoine, AP-HP, Paris A. Abergel, Centre Hospitalier Universitaire de Clermont-Ferrand J.P. Bronowicki, H ô pital de Brabois, Centre Hospitalier Universitaire de Nancy S. Metivier, J.P. Vinel, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse V. De Ledinghen, Hôpital Haut Levêque, Centre Hospitalier Universitaire de Bordeaux O. Goria, Centre Hospitalier Universitaire de Rouen M. Maynard-Muet, C. Trepo, Hôtel Dieu, Hospices Civils de Lyon Ph. Mathurin, Centre Hospitalier Universitaire de Lille H. Danielou, D. Guyader, Hôpital Pontchaillou, Centre Hospitalier Universitaire de Rennes O. Rogeaux, Centre Hospitalier de Chambéry S. Pol, Ph. Sogni, Hôpital Cochin, AP-HP, Paris A. Tran, Hôpital De l’Archet, Centre Hospitalier Universitaire de Nice P. Calès, Centre Hospitalier Universitaire d’Angers T. Asselah, P. Marcellin, Hôpital Beaujon, AP-HP, Clichy M. Bourlière, V. Oulès, Hôpital Saint Joseph, Assistance Publique- Hôpitaux de Marseille D. Larrey, Centre Hospitalier Universitaire de Montpellier F. Habersetzer, Centre Hospitalier Universitaire de Strasbourg M. Beaugrand, Hôpital Jean Verdier, AP-HP, Bondy Pathologists: N. Sturm, Centre Hospitalier Universitaire de Grenoble E.-S. Zafrani, Hôpital Henri Mondor, AP-HP, Créteil

Evaluation du stress oxydant et des défenses antioxydantes chez l’enfant malnutri marocain

In Morocco, malnutrition is a public health problem. Indeed, 25% of 6- to 60-month-old children suffer from malnutrition. Imbalance between antioxidant protection and prooxidant stress has been report

Serum Copper and Protein-Calorie Malnutrition in the Fes Area (Morocco)

Malnutrition is the result of a negative nutritional balance. Protein-calorie malnutrition (PCM) (1,2) is responsible for a high percentage of deaths among young Moroccan children (3). Copper is an essential micronutrient for growth and participates in the oxidative defence. The copper status is modified in malnutrition (4). The aim of the present study was to determine the copper status in young PCM children living in the Fes area.