Elizabeth D. Morrison, MD; David J. Brandhagen, MD; Pradyumna D. Phatak, MD; James C. Barton, MD; Edward L. Krawitt, MD; Hashem B. El-Serag, MD, MPH; Stuart C. Gordon, MD; Mark V. Galan, MD; Bruce Y. Tung, MD; George N. Ioannou, MD, MS; Kris V. Kowdley, MD
*The odds ratio form of Bayes' theorem states that the post-test odds = pretest odds × likelihood ratio. The likelihood ratio is the frequency of a finding in patients with a disease divided by its frequency in patients who don't have the disease.
Grant Support: In part by grants DK02957 and DK 38215 from the National Institutes of Health. Dr. Ioannou is a Fellow at the Health Services Research and Development program of the Veterans Affairs Puget Sound Health Care system.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Kris V. Kowdley, MD, Division of Gastroenterology/Hepatology, University of Washington, 1959 NE Pacific Street, Box 356174, Seattle, WA 98195; e-mail, email@example.com.
Current Author Addresses: Drs. Morrison, Tung, Ioannou, and Kowdley: Division of Gastroenterology/Hepatology, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195.
Dr. Brandhagen: Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Dr. Phatak: Department of Medicine, Rochester General Hospital, 1425 Portland Avenue, Rochester, NY 14621.
Dr. Barton: G-105, 2022 Brookwood Medical Center Drive, Birmingham, AL 35209.
Dr. Krawitt: Department of Medicine, University of Vermont College of Medicine, Given Building, Burlington, VT 05405.
Dr. El-Serag: Houston Veterans Administration Medical Center (152), 2002 Holcombe Boulevard, Houston, TX 77030.
Drs. Gordon and Galan: William Beaumont Hospital, Division of Gastroenterology and Hepatology, 3601 West 13 Mile Road Royal Oak, MI 48073.
Author Contributions: Conception and design: E.D. Morrison, D.J. Brandhagen, P.D. Phatak, E.L. Krawitt, K.V. Kowdley.
Analysis and interpretation of the data: E.D. Morrison, D.J. Brandhagen, H.B. El-Serag, B.Y. Tung, G.N. Ioannou, K.V. Kowdley.
Drafting of the article: E.D. Morrison, E.L. Krawitt, H.B. El-Serag, K.V. Kowdley.
Critical revision of the article for important intellectual content: E.D. Morrison, D.J. Brandhagen, P.D. Phatak, J.C. Barton, H.B. El-Serag, S.C. Gordon, M.V. Galan, G.N. Ioannou, K.V. Kowdley.
Final approval of the article: D.J. Brandhagen, J.C. Barton, H.B. El-Serag, S.C. Gordon, B.Y. Tung, K.V. Kowdley.
Provision of study materials or patients: E.D. Morrison, D.J. Brandhagen, P.D. Phatak, J.C. Barton, E.L. Krawitt, S.C. Gordon, B.Y. Tung, K.V. Kowdley.
Statistical expertise: J.C. Barton, H.B. El-Serag, G.N. Ioannou.
Obtaining of funding: K.V. Kowdley.
Administrative, technical, or logistic support: K.V. Kowdley.
Collection and assembly of data: E.D. Morrison, D.J. Brandhagen, P.D. Phatak, M.V. Galan, K.V. Kowdley.
Morrison E., Brandhagen D., Phatak P., Barton J., Krawitt E., El-Serag H., Gordon S., Galan M., Tung B., Ioannou G., Kowdley K.; Serum Ferritin Level Predicts Advanced Hepatic Fibrosis among U.S. Patients with Phenotypic Hemochromatosis. Ann Intern Med. 2003;138:627-633. doi: 10.7326/0003-4819-138-8-200304150-00008
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Published: Ann Intern Med. 2003;138(8):627-633.
Hereditary hemochromatosis is a common inherited disorder among people of Northern European descent. Screening studies using phenotypic criteria have found a prevalence of 1:200 to 500 and a carrier frequency of nearly 10% (1). Patients with phenotypic expression of this disorder may have evidence of iron deposits in many organs, including the liver, heart, skin, joints, anterior pituitary, and pancreas. Involvement of these organs can lead to cirrhosis and liver failure, cardiomyopathy, skin pigment changes, arthropathy, impotence, and diabetes, respectively. Long-term survival among patients with hemochromatosis who have cirrhosis at the time of diagnosis is statistically significantly lower than that in an age- and sex-matched control group primarily because of a statistically significantly increased risk for hepatocellular carcinoma and liver failure (2, 3). Therefore, it is important to ascertain the presence or absence of advanced hepatic fibrosis or cirrhosis in patients with hemochromatosis, because this information has important prognostic value and will probably change management. In the absence of obvious decompensated cirrhosis, liver biopsy is the only reliable means to identify cirrhosis among patients with hemochromatosis.
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Gastroenterology/Hepatology, Liver Disease.
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