Serum soluble intracellular adhesion molecules-1 [sICAM-1] and AST/ALT ratio in chronic hepatitis C are significant predictors of the disease severity judged by liver biopsy

ABSTRACT

This study was conducted to investigate the serum levels of soluble Fas [sFas] antigen, soluble intracellular adhesion molecules-1 [sICAM-1] and interleukin-18 [IL-18] in patients with chronic hepatitis C and to correlate their levels with the severity of pathological findings judged by liver biopsy interpreted as Scheuer score. The study included 30 patients with chronic hepatitis C [Study group] infection persisting for longer than 6 months with HCV antibody positive and increased serum alanine aminotransferase [ALT] values and 10 volunteers to donate blood samples as control group. After complete history taking and full clinical examination, all patients and controls gave a fasting blood sample for colorimetric estimation of serum aspartate transaminase [AST], ALT and total [TB] and direct [DB] bilirubin and for ELISA assays of serum sICAM-1, sFas and IL- 18 levels. Blind liver biopsies were done and histopathological inflammatory activity [grading, 0-4 scale] and fibrosis stage [0-4 scale] were assessed according to Scheuer classification. Pathological examination of Liver biopsy detected 21 chronic hepatitis specimens and 9 cirrhosis specimens with a significant [p<0.05] increase of Scheuer scores in patients with cirrhosis compared to patients with chronic hepatitis. Serum levels of AST and ALT were significantly [p<0.05] elevated in study compared to control group, with a non-significant [p>0.05] increase of AST/ALT ratio; however, serum AST levels and AST/ALT ratio were significantly [p<0.05] higher and serum ALT levels were non-significantly [p>0.05] higher in cirrhotic patients compared to those with chronic hepatitis. Serum sFas, sICAM-1 and IL-18 levels in study group were significantly [p<0.05] higher compared to controls levels with a significant [p<0.05] increase of sICAM-1 levels and non-significant [p>0.05] increase of sFas and IL-18 levels in cirrhotic patients compared to patients with chronic hepatitis. There was a positive significant correlation between the mean Scheuer necroinflammatory score and serum levels of ALT, sICAM-1 and AST/ALT ratio and between the mean Scheuer fibrosis score and serum levels of ALT, sFas, sICAM-1 and IL-18 and AST/ALT ratio. Logistic regression analysis showed that AST/ALT ratio [beta=0.679, p<0.001] and serum levels of sICAM-1, [beta=0.327, p=0.005] are the most significant predictors of disease severity. It could be concluded that serum levels of sICAM-1, sFas and IL- 18 and AST/ ALT ratio are closely correlated with histopathological results of liver biopsy and thus their elevated levels could be considered pathognomonic markers suggesting the severity of chronic hepatitis C