Clinical Presentation

Anthony66 Male

• 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 36 • BP 160/90

Referral to a Specialist

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 AlamClinical Associate Professor of Medicine

Texas A&M University

A pragmatic risk stratification approach with LIVERFASt™

LIVERFASt™ ResultsFibrosis

0.61F3

Significant Fibrosis

Activity0.66A3

Marked Activity

Steatosis0.80

S3Marked Steatosis

Before LIVERFASt™Laboratory Results• Fasting blood glucose: 260 mg/dl • Triglycerides: 165 mg/dl • HDL: 50 mg/dl• LDL: 140 mg/dl • AST: 65 IU/L• ALT: 70 IU/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)

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)

PATIENT NAME:

DATE OF BIRTH: GENDER: HEIGHT: WEIGHT: BMI:

PHYSICIAN NAME:

FIBRONOSTICS

Activity

0.66Grade A3

Marked Activity

0.66

A3A2 A4A1A0

1.000.750.500.250.00

Steatosis

0.80Grade S3

Marked Steatosis

0.80

1.000.750.500.250.00

S3S2S1S0

0.61

Fibrosis

Stage F3Significant Fibrosis

0.61

F3F2 F4F1F0

1.000.750.500.250.00

TEST SCORES

BIOMARKER RESULTS

LIVERFASt TM

Test id: 45843Reference no: GLJ021031108907

DATE TEST TAKEN:

INTERPRETATION

The result as per the SAF (Steatosis Activity Fibrosis) histological score is estimated at S3-A2-F3. This score indicates you have steatohepatitis (NASH), moderate activity, and significant fibrosis.

AGE: GENDER: BODY MASS INDEX:

Sample Date: November 5, 2020

Result Unit Result Unit

303

187

157

0.6

572

mg/dL

mg/dL

mg/dL

mg/dL

IU/L

alpha-2-Macroglobulin

Haptoglobin

Apolipoprotein A1

Total Bilirubin

GGT

ALT

AST

Fasting Glucose

Total Cholesterol

Triglycerides

67

54

127

208

163

IU/L

IU/L

mg/dL

mg/dL

mg/dL

CLIA# 10D2190357This report is computer generated. No signature required.

66 years old MALE 36

MALE 36

SAMPLE RESULT SHEET

ANTHONY

June 8,1955 6 ft 1 inch 273 lb November 7, 2020

How It Works

FIBRONOSTICS

LIVERFASt Proprietary CPT Code 0166U

Algorithm calculation

Results available real time

Confidential, secure, and automatically sent to physician

Support for interpretation available

Clinician orders LIVERFAStTM for the patientLIVERFASt Proprietary CPT Code 0166U1The patient has a simple fasting blood test of the 10 biomarkers2The lab provides results of the 10 biomarkers3The 10 biomarker results are input into Fibronostics web portal4Fibronostics’ AI technology generates LIVERFAStTM results immediately5

Contact Usservice@fibronostics.comP: 1-888-552-1603 F: 1-321-256-60613452 Lake Lynda Drive, Bldg 100, Suite 151, Orlando, Florida, 32817www.fibronostics.com

PATIENT NAME:

DATE OF BIRTH: GENDER: HEIGHT: WEIGHT: BMI:

PHYSICIAN NAME:

FIBRONOSTICS

Activity

0.66Grade A3

Marked Activity

0.66

A3A2 A4A1A0

1.000.750.500.250.00

Steatosis

0.80Grade S3

Marked Steatosis

0.80

1.000.750.500.250.00

S3S2S1S0

0.61

Fibrosis

Stage F3Significant Fibrosis

0.61

F3F2 F4F1F0

1.000.750.500.250.00

TEST SCORES

BIOMARKER RESULTS

LIVERFASt TM

Test id: 45843Reference no: GLJ021031108907

DATE TEST TAKEN:

INTERPRETATION

The result as per the SAF (Steatosis Activity Fibrosis) histological score is estimated at S3-A2-F3. This score indicates you have steatohepatitis (NASH), moderate activity, and significant fibrosis.

AGE: GENDER: BODY MASS INDEX:

Sample Date: November 5, 2020

Result Unit Result Unit

303

187

157

0.6

572

mg/dL

mg/dL

mg/dL

mg/dL

IU/L

alpha-2-Macroglobulin

Haptoglobin

Apolipoprotein A1

Total Bilirubin

GGT

ALT

AST

Fasting Glucose

Total Cholesterol

Triglycerides

67

54

127

208

163

IU/L

IU/L

mg/dL

mg/dL

mg/dL

CLIA# 10D2190357This report is computer generated. No signature required.

66 years old MALE 36

MALE 36

SAMPLE RESULT SHEET

ANTHONY

June 8,1955 6 ft 1 inch 273 lb November 7, 2020