Document Type : Original article
Authors
1
Biochemistry Division, Chemistry Dept. Faculty of Science, Damietta University, Damietta, Egypt.
2
Internal Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt., Egyptian Liver Research Institute and Hospital (ELRIAH), Sherbin, El-Mansoura, Egypt.
3
Chemistry Department, Faculty of Science, Damietta University, Damietta, Egypt.
Abstract
Liver biopsy is the golden standard but has its complications. Our aim is to establish a method to assess hepatic fibrosis both directly and indirectly, correctly and non-invasively in chronic hepatitis C genotype 4 patients. Also, the diagnostic power of this method will be compared with those of APRI, AAR, FCI, FI, LOK, FIB4, GUCI and KING scores. Samples were collected from 220 patients (F0-F4) of whom 100 were used in the validation study. Hyaluronic acid (HA) and vascular
endothelial growth factor (VEGF) levels, HCV RNA, liver function tests, platelet counts, and liver biopsy were done. HA and VEGF levels were correlated with the severity of the disease and acting as fibrogenic/angiogenic cross linker. The areas under receiver operating characteristic curve (AUCs) of the developed method were 0.979 and 0.994 for significant (F2F4) and advanced fibrosis (F3F4) (cut off= 0.583 and 6.27, respectively). These AUCs were directly based on HA
and VEGF and indirectly on AAR and is termed HA vascular (HAV) method = -35.1+ 0.14 (HA) (ng/L) + 0.03 (VEGF) (pg/ml) + (-6.7) (AAR). Surprisingly, the validation study of this cross linker gave numerical values of AUCs near unity i.e. 0.990, 0.996 and 0.995 for significant, advanced and liver cirrhosis. Also, the indirect published scores gave lower AUCs compared with those of the developed one. Our developed method can not only help to assess liver fibrosis staging
effectively but also avoid the invasiveness and the limitations of liver biopsy in such patients.
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