Cirrhosis Calculator

In case you haven't seen this, the Halt-C site features a neat Cirrhosis  calculator using four common blood tests. http://www.haltctrial.org/  

Just remember, this calculator only works with pre-treatment or post-treatment blood values. You cannot use your lab results taken during treatment.

I'm not suggesting this in lieu of biopsy, or other blood tests your doctor may want to order. It's just one more tool to add to our self-help arsenal.

In my case, I'm a stage 3 but my biopsy was done three years ago in 2002. Although my doctor disagrees, some suggest an 18 month progression from stage 3 to 4.  In any event, the calculator shows me having only a 31% of cirrhosis based on my pre-treatment blood tests. I'll buy that. LOL.

What might be very interesting is for those of you who have kept their lab results, is to check back for labs around the time of your biopsy. Plug the numbers into the calculator and let us know how they match up to the actual biopsy results.

Same thing for those of you who took Fibrosure -- be interesing to see how those results correlate with the calculator as well. Again, you can only use lab work that was done while you were not on treatment.

A couple of more articles on biopsy versus blood tests.

http://tinyurl.com/devqe
http://tinyurl.com/ex6jr

[jmjm530]

Maybe those in the know can help here. I'm confused by the calculator's PT/INR ratio.


In my case, my pre-treat Pro Time is 12.8 and my INR is 1. That would give me a ratio or 12.8? However, the calculator only accepts a result of between .5 and 5.

Both my values are in the normal range so apparently I'm doing something wrong. Intially, I just thought they were using INR so I plugged in the number 1.

[PasoPerson]

My biopsy results were using the Knobell scale of 1-6, where I am a 5, "partially cirrhotic".  

What is the 1-4 scale?  I never quite know where to place myself when I read this forum.

You guys are all TERRIFIC.  All of you.  I am still pre-tx.  First shot/pills will be August 25, Pegasys & Copegus.  That will be three months post-diagnosis.  Can't come soon enough for me!  

Thanks for being here.  Just figured you could answer the scale difference for me.  God bless -

Carolyn

[jmjm530]

The quantitative liver/spleen scan. Anyone have one? It seems to be another interesting diagnostic tool for cirrhosis that I imagine
could be utilized DURING treatment. http://www.haltctrial.org/
Click on the July Newsletter.

Paso,

On a 1-4 scale, I imagine you would be  either between stage 3 and 4 or an early stage 4. Just a guess. Good luck with treatment and keep asking questions. You seem to have a great attitude! BTW do you know your viral load, genotype and how long you will be treating for?

[susan400]

I just got my Fibrosure test back today (done before I started treatment).  It rated me at F2 to F4.  My last biopsy had me at a late stage 2, early stage 3.  So, they pretty much matched up.  No improvement really, but not real progression (which is a real good thing), no cirrhosis (another good thing). So, I guess all my treatments are doing something.

Susan

[jmjm530]

That's pretty cool! I'd like to see some more folks plug numbers in to see if the relationship exists between biopsy score and the calculated results.

Did you just plug the INR into the equation then? That's what I ended up doing. Not sure what they meant by the "PT/INR" ration -- the equation won't accept those numbers as they are out of range.

[carpedi]

I ran my pretreatment/prebiopsy numbers on the calculator. My PT was 13.2 and the INR was listed as the same as yours - a 1. After plugging in my ALT and AST and platelets it calculated a 14% chance. My biopsy showed stage 1, grade 2 so I guess that would be consistent.

[jmjm530]

I believe the formula was tested mostly with stage 3's and 4's. So the even though your percentages were low, they're probably on the high side.

Blood tests like this (and Fibrosure) don't necessarily replace biopsies, but they are being used more and more as a first line test in selected patient populations.
http://www.hivandhepatitis.com/hep_c/news/2005/ad/072205_a.html

That said, many heptologists still scoff at anything but the gold standard needle biopsy. But some others, like Dr. Cecil, are using tests like Fibrosure more and more.

From the little I've read, tests like Fibrosure are most helpful at the extreme end of liver staging. In other words, if the test shows stage 0 or 1, then you probably don't need a biopsy. However, the test is less accurate toward the middle ranges (stage 2 and 3) and you then might want a biopsy to confirm. Personally, if I got a stage 4 via Fibrosure, I'd want to confirmw with needle biopsy.

But speaking of accuracy, there's also alot of controversy regarding how accurate needle biopsies are due to differnces both in the size of the actual sample and the portion of the liver where the biopsy is taken. Studies show results can vary by as much as 2 stages because of these variables.

All said, the more studies/tools we have like this the better decisions we can make about our treatment.

Of course, the test we all want above all is simple blood test that tells us the virus is gone for good, so we would know with 100% accuracy when to stop treatment!  Hopefully, that day will come soon.

[carpedi]

Yeah, I plugged in the INR as it was stated on my report. I had tried the straight PT number and found, like you did, that it kicked it out as too high. I guess you kind of have to work backwards - find out what is acceptable and then go look for it. Just like in real life!

[Pixie Dust]

WOW.  I'm a geno 1a my bx showed stage 2.  (I go Talk to my doc on the 3rd about treatment.  Yes I'm looking forward to it.) platlets 307, pt .09, ast 40, alt 46.  Came out to be 8%.  i did notice the platlets have alot to do with the result I typed in 37 in error and my chance was 49%.  So I played around with other numbers and with each one there was a differance in the percentage.  In fact at one point my platlets were 330 and my percentage went down.

[new-sojourn]

To not progress is excellent news, considering the options.  My friend Jack Slater (who has an ongoing account in the Seattle Times about his hep c and transplant) emailed me w/an update.  His new liver-in 8 mos-is now @ stage 3.  So he's 'seriously considering' tx now.  He's a 1a.

Now I tx'd and cl'd-2b-and am probably regressed a stage after 3yrs SVR.  So I'm prob a 3 also now.  b/don't have to take expensive meds for life.

To not be any worse is a sizable victory, considering everything.

[susan400]

That's how I feel.  I think that all my treating could have helped keep things in check, even if I haven't had any remission (SVR) and even if I haven't had any reversal of damage.  As long as I'm not getting any worse, that's fine with me.

Susan

[Tinsnip]

Having Hep 2b and being most of the way through treatment is no guarantee that I know what the heck is going on. I check in here from time to time and realize you have all spent some considerable time researching and understanding the science behind the treatment and diagnosis. Guess I'm feeling a little dumb.

For instance, the only pre-treatment liver assessment I had was a sonogram which looked normal. No biopsy. At 10 weeks ( I'm currently at 17 of 24 weeks and I just found this out two days ago since I missed my last appointment) the viral load was "undetectable". Yet, in many of the posts here there are discussions of "stages" and cirrohsis levels. What are the stages you refer to? Should I be more concerned with liver condition beyond just clearing the virus? Clinic says probably will not do a biopsy even after treatment. They seem confident I'll be clear and clean. Sound right?

Thanks!