Clinical evaluation of son invasive biomarkers for monitoring liver fibrosis and disease progression

ABSTRACT

Liver biopsy is the gold standard for assessment of hepatic fibrosis. However, it is invasive with possible complications, costly and prone to sampling errors. Many non-invasive markers of liver fibrosis have been recently proposed and assessed in the clinical setting as surrogates of liver biopsy. Although several non invasive markers of liver fibrosis have been developed in the last decade their implementation in clinical practice has been slow and is still limited. This study aimed to describe the different non invasive markers and methods that have been proposed for the assessment of liver fibrosis, to discuss their advantages and limits and to suggest a rational use in clinical practice. This study included 40 patients with chronic liver disease, 21 of chronic hepatitis C [CHC] as group I, and 19 patients with liver cirrhosis [group 11] as well as 20 healthy subjects with age and sex matched was enrolled as control group. Serum levels of tissue inhibitor of metalloproteinase- 1 [TIMP-I], laminin and cystatin C were measured and correlate with laboratory and histological findings. This study revealed that, significantly elevated serum level of cystatin C in CHC [group I] and cirrhotic patients [group II] than healthy controls [p<0.001] for each. Moreover, cystatin C concentrations were significantly higher in patients with liver cirrhosis [p<0.01] than in patients with CHC. Furthermore, serum cystatin C levels correlated significantly with the stage of liver fibrosis [p<0.01] but revealed no significant difference with the grade of necroinflammation of the disease process [p>0.05]. However, serum TIMP-1 values showed a significant increase in group I and 11 patients than in controls. Serum TIMP-1 levels correlated significantly with both the stage of fibrosis [p<0.05] and the grade of activity [p<0.01]. Serum larninin levels showed significant increase in patients with chronic hepatitis and liver cirrhosis than controls [p<0.001]. While, no significant difference of on comparing chronic hepatitis patients with control group [p>0.05]. Also, serum laminin levels showed a significant correlation with fibrosis stage [p<0.001] but not with inflammatory grade [p>0.05]. Based on available evidence, it can be anticipated that non-invasive markers of liver fibrosis [cystatin C, TIMP-1 and laminin] and their combined use will soon become a most useful tool in the clinical management of many forms of chronic liver disease. However, their implementation is expected to reduce, but not to completely eliminate, the need for liver biopsy