Patient case studies
A Pragmatic risk stratification approach with LIVERFASt™
LIVERFASt™ Patient: Case-01
Anthony
66 | Male
Clinical Information
- Presents to PCP with moderate fatigue and malaise
- Patient gained 20 pounds over the last 12 months
- Uncontrolled Diabetic
- Currently taking Diovan HCT 320mg/25mg and Janumet 50/500mg
- Past medical history of hypertension, diabetes, and CKD stage 3
- No family history of medical problems
- BMI 40
- BP 160/90
I use LIVERFAStTM as a risk stratification tool in patients with possible non-alcoholic fatty liver disease. A pragmatic risk stratification approach is important to identify patients at risk of advanced fibrosis in a cost- effective fashion.
Dr. Imtiaz Alam
Clinical Associate Professor of Medicine Texas A&M University
Anthony
66 | Male
Clinical Information
- Presents to PCP with moderate fatigue and malaise
- Patient gained 20 pounds over the last 12 months
- Uncontrolled Diabetic
- Currently taking Diovan HCT 320mg/25mg and Janumet 50/500mg
- Past medical history of hypertension, diabetes, and CKD stage 3
- No family history of medical problems
- BMI 40
- BP 160/90
I use LIVERFAStTM as a risk stratification tool in patients with possible non-alcoholic fatty liver disease. A pragmatic risk stratification approach is important to identify patients at risk of advanced fibrosis in a cost- effective fashion.
Dr. Imtiaz Alam
Clinical Associate Professor of Medicine Texas A&M University
Before LIVERFASt™
Laboratory Results
Fasting Blood Glucose: 260mg/dl
Triglycerides: 165mg/dl
HDL: 50mg/dl
LDL: 140mg/dl
AST: 65U/L
ALT: 70U/L
Clinical Assessment
Poorly controlled Diabetes Mellitus
Morbid Obesity
Hypertension
Elevated Liver Function Tests
What to do next?
Risk management of Diabetes Mellitus
Hypertension management
Order LIVERFASt™
“There should be a high index of suspicion for NAFLD and NASH in patients with type 2 diabetes” (Chalassani N et al. Hepatology 2018. AASLD CPG)
“In patients with type 2 diabetes, the presence of NAFLD should be looked for irrespective of liver enzyme levels, since type 2 diabetes patients are at high risk of disease progression “ (Chalassani N et al. Hepatology 2018. AASLD CPG)
LIVERFASt™ Results
Fibrosis
0.61
F3
Significant Fibrosis
Activity
0.66
A3
Moderate Activity
Steatosis
0.80
S3
Severe Steatosis
After LIVERFASt™
Patient stratified as high risk of NASH or advanced fibrosis.
“Patients with steatosis identified by steatosis biomarkers and having metabolic medium/high risk (indicative of significant fibrosis or cirrhosis using fibrosis biomarkers), in the presence or not of abnormal liver enzymes should be referred to a specialist for in-depth assessment of disease severity, decision to perform liver biopsy, initiate monitoring/therapy.” (EASL-EASD-EASO. J Hepatol 2016 CPG)
How it works
Clinician orders LIVERFASt™ for the patient
The patient has a fasting simple blood test of the 10 biomarkers
The lab provides analyses of the 10 biomarker results
The 10 biomarker results are input into Fibronostics web portal
LIVERFASt™ results are available immediately
LIVERFASt™ Patient: Case-02
Sophia
65 | Female
Clinical Information
- Presents to PCP with moderate arthralgia, fatigue, and weight gain
- Currently taking Diovan 160mg
- Past medical history of hypertension
- No family history of medical problems
- BMI 34
- BP 145/80
I use LIVERFAStTM as a risk stratification tool in patients with possible non-alcoholic fatty liver disease. A pragmatic risk stratification approach is important to identify patients at risk of advanced fibrosis in a cost- effective fashion.
Dr. Imtiaz Alam
Clinical Associate Professor of Medicine Texas A&M University
Sophia
65 | Female
Clinical Information
- Presents to PCP with moderate arthralgia, fatigue, and weight gain
- Currently taking Diovan 160mg
- Past medical history of hypertension
- No family history of medical problems
- BMI 34
- BP 145/80
I use LIVERFASt™ as a risk stratification tool in patients with possible non-alcoholic fatty liver disease. A pragmatic risk stratification approach is important to identify patients at risk of advanced fibrosis in a cost- effective fashion.
Dr. Imtiaz Alam
Clinical Associate Professor of Medicine Texas A&M University
Before LIVERFASt™
Laboratory Results
Fasting Blood Glucose: 126mg/dl
Triglycerides: 130mg/dl
HDL: 55mg/dl
LDL: 55U/dl
AST: 19U/L
ALT: 60U/L
Clinical Assessment
Metabolic Syndrome
Obesity
Elevated Liver Function Test
What to do next?
Risk management of metabolic syndrome
Hypertension management
Order LIVERFASt™
“Obesity (excessive body mass index [BMI] and visceral obesity) is the most common and well- documented risk factor for NAFLD. “ Subichin M, et al.. Surg Obes Relat Dis 2015
“BMI and waist circumference, a measure of visceral adiposity, are positively related to the presence of NAFLD [51] and predict advanced disease, particularly in the elderly“ (Bedogni G, et al. Hepatology 2005)
LIVERFASt™ Results
Fibrosis
0.20
F0
No Fibrosis
Activity
0.62
A1
Moderate Activity
Steatosis
0.39
S1
Mild Steatosis
After LIVERFASt™
Patient stratified as intermediate risk of NASH or advanced fibrosis. Reassessment in 6 months with LIVERFASt test.
“Patients having metabolic risk factors and steatosis in the presence of abnormal liver enzymes should be referred to a specialist for in-depth assessment of disease severity, decision to perform liver biopsy, and initiate monitoring/therapy.” (EASL-EASD-EASO. J Hepatol 2016 CPG)
How it works
Clinician orders LIVERFASt™ for the patient
The patient has a fasting simple blood test of the 10 biomarkers
The lab provides analyses of the 10 biomarker results
The 10 biomarker results are input into Fibronostics web portal
LIVERFASt™ results are available immediately
LIVERFASt™ Patient: Case-03
Ronald
45 | Male
Clinical Information
- Presents to PCP with increased moderate fatigue and malaise
- No current Medications
- No significant past medical history or family medical history
- BMI 30
- BP 125/70
A pragmatic risk stratification approach is important to identify diabetic patients at risk of advance fibrosis in a cost-effective fashion. I recommend using LIVERFASt™ as a screening blood test by a primary care provider [PCP].
Dr. Imtiaz Alam
Clinical Associate Professor of Medicine Texas A&M University
Ronald
45 | Male
Clinical Information
- Presents to PCP with increased moderate fatigue and malaise
- No current Medications
- No significant past medical history or family medical history
- BMI 30
- BP 125/70
A pragmatic risk stratification approach is important to identify diabetic patients at risk of advance fibrosis in a cost-effective fashion. I recommend using LIVERFASt™ as a screening blood test by a primary care provider [PCP].
Dr. Imtiaz Alam
Clinical Associate Professor of Medicine Texas A&M University
Before LIVERFASt™
Laboratory Results
Fasting Blood Glucose: 215mg/dl
HbA1c: 9%
Triglycerides: 215mg/dl
HDL: 60mg/dl
LDL: 100mg/dl
AST: 19U/L
Clinical Assessment
Newly diagnosed Diabetes Mellitus
Does Ronald meet the criteria of Metabolic Syndrome?
What to do next?
Treat for Diabetes Mellitus
Risk management of metabolic syndrome
Order LIVERFASt™
“There should be high index of suspicoin for NAFLD and NASH in patients with type-2 diabetes” (Chalassani N et al Heptology 2018 AASLD CRG)
“In patients with type 2 diabetes, the presence of NAFLD should be looked for irrespective of liver enzyme, since type-2 diabetes patients are at high risk of disease progression” (Chalassani N et al Heptology 2018 AASLD CRG)
LIVERFASt™ Results
Fibrosis
0.27
F0
No Fibrosis
Activity
0.41
A1
Minimal Activity
Steatosis
0.48
S1
Mild Steatosis
After LIVERFASt™
Patient stratified as a low risk NASH or advance fibrosis. Monitor for new risk factors.
“To Monitor disease severity in “Low Risk” patients (indictive of non/mild fibrosis) with NAFLD, a follow up every 2 years is indicated using Liver enyzmes and fibrosis biomarker”
(EASL-EASD-EASO. J Hepatol 2016 CPG).
How it works
Clinician orders LIVERFASt™ for the patient
The patient has a fasting simple blood test of the 10 biomarkers
The lab provides analyses of the 10 biomarker results
The 10 biomarker results are input into Fibronostics web portal
LIVERFASt™ results are available immediately
