89. When the same threshold was used, sensitivity and specificity were 83 and 81% respectively, with PPV and NPV of 91 and 68%, respectively (Fig. 5). Fig. 5 A proprietary algorithm that includes breath-test parameters, age inhibitor Tofacitinib and other patient data to differentiate intrahepatic inflammation (HAIa + HAIb + HAIc + HAId �� 4 vs > 4) applied on the 67% of the patient population assessed by the fibrosis … Applying the described inflammation algorithm on the subset of patients not analysed by the fibrosis algorithm (33% of the initial population), resulted in an area under the ROC of 0.96. When the same threshold was used, sensitivity and specificity were 82 and 91%, respectively, with PPV and NPV of 95 and 71%, respectively (Fig. 6). Fig.

6 A proprietary algorithm that includes breath-test parameters, age and other patient data to differentiate intrahepatic inflammation (HAIa + HAIb + HAIc + HAId �� 4 vs > 4) applied on the 33% of patient population not assessed by the fibrosis … Discussion We assessed the ability of the noninvasive, online, continuous 13C-MBT in the detection of significant fibrosis and inflammation in patients with HCV. In a cohort of 100 consecutive HCV patients with normal ALT, breath-test parameters correlated with the level of fibrosis and degree of inflammation as indicated by the modified Ishak HAI fibrosis and inflammation scores. The breath test accurately differentiated low and high inflammation (��4 and >4, 83%). The MBT achieved a 90% diagnostic accuracy in differentiating patients with a modified Ishak HAI fibrosis score ��2 and >2 while 67% of the biopsies could have been avoided by replacing the assessment with the MBT alone.

Methacetin breath testing has been correlated with fibrosis and overall liver function [16]. Traditionally, this testing was performed using isotopic ratio mass spectrometry, the gold standard for MBT. However, a recent study found that a measurement method with continuous automatic molecular correlation spectroscopy showed a high correlation with mass spectroscopy [17]. In addition to being less cumbersome, the continuous system has an inherent advantage over mass spectrometry in its ability to identify the PDR peak and PDR peak time, which are often missed when noncontinuous measurement is used. Furthermore, being fully automatic and using an internal capnograph, the system mitigates the risk of potential human errors and ensures that the appropriate part of the breath sample is collected. Several noninvasive methods have been explored as tools to assess the degree of liver fibrosis in chronic HCV patients, and some were also evaluated in patients with normal ALT. These include a combination of serum tests such as the AST/ALT ratio Cilengitide [18] or the AST/platelet ratio index [19].