Fibrospect II

Hi all- My husband just recieved his FibroSpect II results today- the score was 67. I know that 0-41 is Stage 0-1 and over 41 is Stage 2-4, but can anyone tell me about what stage 67 would be? I know the only way to get the real answer is a biopsy, but hubby doesn't wanna do that. So I'm left to wait... the gastro seemed very relaxed about the whole deal, said that waiting a year or so and thinking things over won't hurt. Also said if he's not gonna tx, there's really not much point of a bx. But I asked if it looks like hubby is likely to run into trouble with his liver in the next few yearsv (meaning lefethreatening) and he said nope. Spleen is normal from what the ultrasound showed which is good and also platelets rose friom 99 in 2006 to 165 last blood test in March 2007. So does anyone have any info on this 67 score? Or a similar score? Thanks for any advice. -Dee

[GrandmaA]

I don't know anything about that test. How old is your hubby? It's usually the bx results that causes us to treat. Why doesn't he want a bx? Mine was a cinch, no problem and very quick. What genotype is he? Can you get a hepatologist? His doctor sounds a little nonshallant to me. The older we get the more chance of eventually getting liver cancer - then you can go really fast.

[dlr2007]

Hi- Thanks for your reply. My hubby is 53 and has probably had hep c for at least 20 years. He had a bx about 10 years ago and doesn't like the recovery time as in laying on his side in the hospital- or at least that's the reason he gives. I wonder if he just might be afraid to know for sure what shape his liver is in, cuz  if it's bad he'll have to face tx. His doc says there is definitely some scarring taking place in his liver, but he doesn't think it's severe enough to cause illness in  the near future. I guess this is good news...?  Thanks! -Dee

[Eisbein]

A score of 67 puts your hubby towards later stage 3, with a sensitivity of index value at 49.2%, and a predictive value 86.8%.
There is room for error at stage 2 and 3, sometimes a whole stage.
Platelets can jump around during their primary trend, which in your husbands case seems to be down. At 165 they are consistend with middle of the road stage 3, not forgetting that they were 99, which is chirrhosis.
Look at his Albumin, Bilirubin, and Prothrombin time, maybe you can post those numbers and the picture becomes clearer.
Hopefully they measurerd your husbands spleen size with the ultrasound, and not just said it's normal. Normal is under 12 inches.
Try to get him to consider tx.

Ina

[Eisbein]

I meant to say 12 cm, sorry.

Ina

[susan400]

My Fibrospect II score was a 93.  My doctor said that from stage 2-4 that the Fibrospect had some speculation on how accurate it was when comparing to a biopsy.  My doctor looked at the Fibrospect II as just another tool to use in looking at the overall picture.  

Susan

[jmjm530]

My understanding is that Fibrospect is reasonably accurate for predicting stage 0-1 but not very accurate for the middle stages.

[FlGuy]

Hubby needs to face a little logic if the doc suggests a bx to get the best assessment of liver fibrosis/cirrhosis and decision to treat scenarios.  If hubby is like many people in the age range, he'd think nothing of being couch-bound to watch  football, baseball, hoops or racing for hours on a weekend.  So what's a couple of hours laying on his side on a gurney?  He needs to buck-up a bit and take a look at the big picture.

[motheroffour]

I guess I'd tell him to go for the biopsy, too if he has that option, especially if he has been diagnosed  for Hep C and knows his viral load.  My husband rolled into his biopsy with a normal ultrasound, a CAT scan and a MRI that all looked normal except for identifying some cysts on his kidney's which are nothing....came out of the biopsy with a diagnosis of probable cirrohsis. A huge shocker.  His clotting time was alittle off, his liver enzymes were just a tiny bit elevated, his platlets were at the low end of normal. Every year for his entire life  prior to this appointment everything was in the normal range. The CAT and MRI came after the Hep C diagnosis and were prescribed by his family doc.  The gastro he was referred to prescribed the bx and later an endoscope.  If his bx comes back just fine then he can relax on the couch knowing he's been judged by the best standard of practice at this time.

[dlr2007]

Hi- Thank you to all of you for your replies. It's so helpful to come here and get specific answers, since sometimes I leave the dr's with questions I either didn't ask or didn't get a satisfactory answer for. I told my hubby that his Fibrospect score was consistent w/ stage 3 damage with some room for error. He has chosen not to educate himself on Hep C so it's very hard to discuss it with him. I think I come across as talking a different language half the time, which only frustrates him. I just want to make sure that he doesn't just blow this off because of the comforting manner of his gastro. But I also don't want to come on too strong since this is not a medical emergency and chancxes are one more year won't make much difference- I hope! Hubby just got over a terrible bout of pleurisy, lost his Mom to cancer, and has a teenage son that is in bad legal trouble. So he really has a lot to deal with right now. I just don't want to see him let months turn into years and go back to the dr to hear, "Sorry you let this go too long- you can't treat now."
  Anyway! Eisbein (I apologize if I'm mispelling this!) here arehubby's blood test results.
Coagulation- INR- 1.8     Prothrombin time- 12.4  
Albumin- 3.3  Low (but he was sick w/ pleurisy at the time)
Alkaline Phosphatase- 77
AST- 53 High
ALT- 55 High
Total Bilirubin- 0.7
Potassium- 4.3
Chloride- 99 Low   101-111 range
Carbon Dioxide- 33 High 20-32 range
Platelet count- 165
MPV- 7.5 Low
Differential- Polys- 74.4 High 50-70% range
Lymphs- 18.8 Low 25-45 % range
Eosiniphils 1 Low 2-5%
monos and basophils normal
Absolute Count- NE # 5.7 High 2.2-4.8 10^3/uL
all else normal on absolute count
Cholesterol is usually 205
Thanks so much for your help! -Dee

[dlr2007]

Hi- I was busy all day yesterday and am just catching up on the posts today, but I wanted to specifically reply to you both.
Grandma, my hubby is genotype 1 (not sure if it's a or b) and so am I. The doc says that the genotpe combined w/ high viral load (5 million) lowers my husbands chances for SVR, which is another reason he doesn't push harder for tx. He doesn';t seem to take into account the break your liver gets from tx, but when I pointed it out he agreed.
Motheroffour, I'm sorry to hear about your hubby's diagnosis on the bx- even though it's not the end of the world, I thinbk it can seem like it esp. when you're not expecting it. I hope he's doing well now. I compare my husband to the ostrich with it's head in the sand- he just doesn't wanna deal! I kinda wish his doc had been a bit more forceful, but at the same time, with everything he's been thru lately, maybe one more health problem might push him right over into complete denial or depression! It's diffucult to deal with loved ones health issues as well as our own. But at least at this forum we're not alone!
-Dee

[jmjm530]

I would not weigh your husband's Fibrotest score of .67 too heavily in terms of any future treatment decisions. Liver biopsy or the newer non-invasive Fibroscan test (where available) will yield more accurate results. Good luck moving forward!

-- Jim

Re: Fibrospect II

"The limitation of this test is its decreased sensitivity and specificity in the middle of the test's reporting range between scores of 0.42 and 0.80."

http://tinyurl.com/26gppa (Full Abstract)

[dlr2007]

Hi- Mu husband's gastro had actually ordered a FibroScan for him, then realized that cuz it's considered experimentary, it must be followed by a biopsy. We are, however, near Boston- about 30 minutes away. I wiould like to contact these Dr's you mentioned, but assuming insurance doesn't cover FibroScan, how much does it cost? I know my husband would refuse tp spend a lot on it, He really makes this difficult, Do you have any idea how long it usually takes a non-drinking mid-Stage 3 to progress to Stage 4? This is assuming that hubby is actually at mid Stage 3. I'm just wondering if there is any average length of time- I know everyone is different. I just don't want to be tiptoeing around this subject to avoid upsetting hubby if it's going to put him in danger in a year or so. Thanks so much for your help. -Dee

[jmjm530]

Until your husband is ready for a biospy, you might start inquiring about getting a Fibroscan. If you liver near Boston or Miami, you could contact the offices of Dr. Schiff or Dr. Afdhal. If you liver near San Francisco, you could post to "Kalio1" who can contact a researcher that may be still be taking on selected patients for Fibroscan. I've also heard that some hospitals are starting to order Fibroscans outside the trial. You might therefore call the Hepatology department of your local teaching hospital and inquire if and when Fibroscan will be available.

All the best,

-- Jim

[dlr2007]

Hi- Thank you for your encouraging words. I'm so anxious to know the truth about my hubby's liver condition that I put everything into one test or statistic- I know I must look at the big picture. And I will just keep reminding him to get the bx and not put it off too long. I'll be finding out about my Fibrotest II score in May, so I may be getting a bx and tx soon too. I'm ready to deal with what I must to be as healthy as I can. Have a great day and thanks for replying- I really value the information you share on this forum. -Dee

[Eisbein]

It would be a good idea to repeat the CBC and CMP, because pleurisy can throw albumin, carbon dioxide, neurophils, etc off.
His PT is time normal, but INR is not. INR stands for "International normalized ratio."
It was created so that PT time all over the world could be interpreted correctly. It is a calculation derived from the PT, but unfortunately different labs use different reagents (tissue thromboplastin). The reagents come with a sensitivity index from the manufacturer. In an ideal world, all manufacturers would have the same sensitivity index, but they do not.
It is unusual to have a very normal PT, and an abnormal INR, since they are a reflection of each other.

I give you my results from our local Lab:
Pt 12.1 (normal range 11.9-15)
INR 0.9  (normal range 0.9-1.2)

I would repeat the PT as well, at a different Lab, preferably a reputable one like Quest.

Bilirubin looks good, at least we got that :)

That Fibroscan Jim talked about is a good idea, but if the scan is still in the testing phase, he would also need a biopsy.
They told me I would need have at least one indicator signaling cirrhosis...Albumin below 3.5, or platelets below 100, and they would take me without a biopsy. But I was on tx when I called, and my Albumin had already risen, and I was not accepted.

Ina