Utility of hepatic or total body iron burden in the assessment of advanced hepatic fibrosis in HFE hemochromatosis.

Development of advanced hepatic fibrosis in HFE Hemochromatosis (HH) isinfluenced by hepatic iron concentration (HIC) and age. In patients with HH, itis important to assess the likelihood of cirrhosis and thus the need forconfirmatory liver biopsy. Therapeutic phlebotomy also provides an estimate ofmobilisable iron stores. We determined whether mobilisable iron stores maypredict the presence of advanced fibrosis. Retrospective analysis of 137 male and 65 female HH subjects was undertaken. Biochemical, histological and phlebotomy data were available on all subjects. The mean values of HIC, HIC × [age], mobilisable iron, mobilisable iron × [age] and serum ferritin in the cohort were higher in the group with advanced fibrosis. HIC had an optimum sensitivity and specificity of 73% for the diagnosis of advanced liver fibrosis, with a cut-offHIC level of 200 µmol/g (AUROC 0.83, p < 0.0001). AUROC for HIC was greater infemales (0.93) than males (0.79). Mobilisable iron had an optimum sensitivity and specificity both of 83% at a cut-off of 9.6 g for the prediction of advancedfibrosis in all subjects (AUROC 0.92, p < 0.0001). Mobilisable iron storesprovide a simple, clinically useful indication of the risk of advanced fibrosisand should routinely be considered.