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Hep C Discussion Forum -> Post Treatment -> My Fib-4 online calculator 2 year pre & post Harvoni comparison
Post Info TOPIC: My Fib-4 online calculator 2 year pre & post Harvoni comparison
Jaded


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My Fib-4 online calculator 2 year pre & post Harvoni comparison
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mallani wrote:

Hi Jaded,

I understand your desire to see some resolution of your cirrhosis. You may have seen my post where I had both FibroScan and biopsy performed recently.

I suggest you get a repeat FibroScan, but it's early days yet.

Fib-4 is easily calculated:

http://www.thecalculator.co/health/Fibrosis-4-%28FIB-4%29-Score-Calculator-702.html

Using this, I just calculated my FIB-4 on the day I had my first FibroScan in 2008. The FibroScan score was 30.1, but the FIB-4 score was only 2.98. I undoubtedly had cirrhosis, with an enlarged, hard liver, enlarged spleen and some early changes of portal hypertension. I also have calculated my FIB-4 at SOT in 2012. It was 2.77.

Your enzymes are now lower which is to be expected. Your liver inflammation will have virtually disappeared. Also, low platelets are usually due to portal hypertension/ or splenic engorgement. This is one of the first things to resolve after the virus is cleared. So the increase in platelets is also to be expected. The changes in your AST, ALT and platelets have all had an influence on reducing your FIB-4 score.

FIB-4 is of some use in deciding who needs biopsy, prior to treatment. The ELF test is used here. There has not been any study of these indirect marker tests after SVR, and I question whether they are of much use. This is what your doctor means- the liver inflammation has gone but resolution of cirrhotic bands may take years.

It's only 3 months since EOT for you. SVR is yours and I hope your liver will resolve by one or two stages in time. Cheers.

 Thank you for weighing in...I hoped you would. Indeed I did see your post and your sticky about the grading system. I guess this online calculator is of no merit then. In any event...after looking at your link I realize that my score would fall into the inconclusive category...which basically means neither here nor there if I am correct and nothing more.



-- Edited by Jaded on Friday 29th of January 2016 06:07:08 AM

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64 year old EOT 10-28-15,SVR24 April 21 2016  ALT-12/AST-23 June '19 - fibroscan 6.9 F-0 July '19
mallani


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Hi Jaded,

I understand your desire to see some resolution of your cirrhosis. You may have seen my post where I had both FibroScan and biopsy performed recently.

I suggest you get a repeat FibroScan, but it's early days yet.

Fib-4 is easily calculated:

http://www.thecalculator.co/health/Fibrosis-4-%28FIB-4%29-Score-Calculator-702.html

Using this, I just calculated my FIB-4 on the day I had my first FibroScan in 2008. The FibroScan score was 30.1, but the FIB-4 score was only 2.98. I undoubtedly had cirrhosis, with an enlarged, hard liver, enlarged spleen and some early changes of portal hypertension. I also have calculated my FIB-4 at SOT in 2012. It was 2.77.

Your enzymes are now lower which is to be expected. Your liver inflammation will have virtually disappeared. Also, low platelets are usually due to portal hypertension/ or splenic engorgement. This is one of the first things to resolve after the virus is cleared. So the increase in platelets is also to be expected. The changes in your AST, ALT and platelets have all had an influence on reducing your FIB-4 score.

FIB-4 is of some use in deciding who needs biopsy, prior to treatment. The ELF test is used here. There has not been any study of these indirect marker tests after SVR, and I question whether they are of much use. This is what your doctor means- the liver inflammation has gone but resolution of cirrhotic bands may take years.

It's only 3 months since EOT for you. SVR is yours and I hope your liver will resolve by one or two stages in time. Cheers.



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Geno 1b, IL28B CT,  x3 prior relapser,  ex-cirrhotic, 75 yo, did 48 weeks with Victrelis/Peg./Riba.  VL 1.28m at start, UNDET. at 8 ,12 ,16 ,24 ,30  and 48 weeks.  EOT 15 Feb 2013 , UNDET. at EOT + 28 weeks. SVR!  Still Undet. at EOT +5 years

Malcolm
Jaded


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I emailed those 2 comparisons to my Dr...he replied back pretty quickly and said...

"That's not really the way that FIB-4 scores are interpreted. It would take a more lengthy explanation so if you wish, feel free to make an appointment to see me and discuss."

I was hoping he'd say something a little more encouraging. Of course I am aware that he makes his conclusions using a variety of calculations and his fibroscan machine (he owns one of the only 2 in this city). I'm not entirely convinced that a fibroscan score makes any distinction between hardness caused by inflammation which can quickly be lessened after SVR (I have notably less inflammation and hardness all over my body these days compared to before tx)...vs hardness caused by fibrosis. How could it possibly make the distinction? Hardness is hardness to a machine I'd think. A biopsy is a tiny sample...I'd think that even a rotten liver might have at least a few tiny sample that look pretty good...as a pretty healthy liver might also have a few horribly bad samples. I'm just a layman but I'd think luck of the draw must come into play when it comes to biopsies.

I would love to think that there is merit to that online calculator...it would certainly put my mind at ease but I just don't know.

My 12 week EOT viral test should come in any day now. My energy is finally beginning to improve after 3 months. Thinking about all this (the Fib4- score) gave me a headache.

 



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64 year old EOT 10-28-15,SVR24 April 21 2016  ALT-12/AST-23 June '19 - fibroscan 6.9 F-0 July '19
Tig


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I looked at that same chart as I was researching your question. According to your results, you are correct. The FIB 4 and the Fibrosure require attention to the individual blood markers and provided there are no issues that might alter the actual blood test results, medication, disease, etc., then they are fairly accurate but not precise. According to your figures in the previous post, the results, in my opinion indicate a reduction from F3-4 to F0-2. A biopsy or Fibroscan to confirm these figures would be ideal, but that's often not available. I would place more trust after confirmational testing is completed over a period of time, which will happen I'm certain. So your results do indeed show some very positive reduction in your fibrosis.

"In conclusion, a FIB-4 index beyond 1.45-3.25 is accurate to differentiate nil-moderate (F0-F2) from severe (F3-F4) liver fibrosis in HCV mono-infected patients. In these ranges, the FIB-4 index could replace advantageously expensive and/or invasive methods to assess liver fibrosis, especially in endemic countries were these techniques are barely available."

FIB 4



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Tig

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Linuxter


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Hi Jaded,

No idea how accurate that would be or if it even applies to the same numbers (charts) that we are used to seeing but I did see the terms "estimate" and "HIV/HCV co-infection" and "2006" on that page. I didn't see a chart or legend how those numbers are associated to F0-4. I'd be very cautious about reading anything into that. (It appears to me that the study was an argument for using calculations to predict vs biopsy and that argument was made in 2006 ... there were, no doubt arguments against as well)

With that said, you may indeed be recovering nicely, I'm not trying to say you are not.

I think the only reliable way to know your liver condition is to get a Fibroscan, FibroTest or Biopsy.

No idea what these calculators were designed for (I do know that the website is for University courses so using the calculator only may be out of context and go along with other tools etc. ) It appears to be a comparison to Biopsy but like I said (out of context?)

    Hopefully someone who knows something about this calculator can chime in.

Dave



-- Edited by Linuxter on Friday 29th of January 2016 03:51:42 AM

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63yy,HCV,2b,F3-A1, Sof/Riba,12wks Tx   SOT: 1/20/16, HCV-RNA 9,816,581, ALT 56, Hb 14.6

4wk: HCV-RNA <15 Detected, ALT 15, AST 17, Hb 13.6 EOT: 4/12/16, ALT 18 , Hb 12.9176a2f85d05d9c965eafe199f2ba9ba5.jpg SVR Achieved 7/8/16

 
Jaded


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Medscape fib-4 chart.jpg

I don't want to get too excited but if I'm not mistaking this suggests I have gone from F4 to F2? How accurate and reliable is this test? My meld score is now .651...it was 1.083 in 2014.

 

Jan 28 2014 Fib-4 calculator score.jpgJan 21 2016 Fib-4 calculator score.jpg



-- Edited by Jaded on Friday 29th of January 2016 03:19:55 AM

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