ABSTRACT
AIM: To evaluate serum growth arrest-specific gene 6 (Gas6) concentration as a biomarker of liver fibrosis progression. MATERIALS & METHODS: One hundred and thirteen consecutive patients affected by chronic liver disease underwent transient elastography, Gas6 measurement and, if clinically indicated, liver biopsy. RESULTS: Gas6 concentration was directly correlated to liver stiffness (r = 0.67; p < 0.0001) and was significantly higher in patients with advanced fibrosis (Ishak 4-5; p < 0.001). A plasma concentration <30 ng/ml Gas6 ruled out fibrosis with 84% sensitivity and 56% specificity, while values >42 ng/ml identified severe fibrosis with a sensitivity of 64% and a specificity of 95%; the diagnostic accuracy was comparable to that of transient elastography. CONCLUSION: Gas6 is a novel biomarker of liver fibrosis, with a potential clinical and pathophysiological relevance.
Subject(s)
Biomarkers/blood , Intercellular Signaling Peptides and Proteins/blood , Liver Cirrhosis/diagnosis , Aged , Area Under Curve , Elasticity Imaging Techniques , Female , Hepatitis B/complications , Hepatitis B/diagnosis , Hepatitis B/epidemiology , Hepatitis C/complications , Hepatitis C/diagnosis , Hepatitis C/epidemiology , Humans , Liver/physiopathology , Liver Cirrhosis/etiology , Liver Cirrhosis/pathology , Male , Middle Aged , ROC Curve , Sensitivity and SpecificityABSTRACT
BACKGROUND: In hypertension clinics, screening patients for the metabolic syndrome (MetS) is common practice, while performing the cumbersome oral glucose tolerance test (OGTT) is not. How large is the underestimation of diabetes and prediabetes that ensues is unknown. METHODS: We recruited N=1397 patients with essential arterial hypertension who underwent a 75-g OGTT and were classified as normally glucotolerant (NGT) or having impaired glucose metabolism (IGM), and as affected or not by MetS (ATPIII criteria). The agreement between the OGTT and the ATPIII criteria in attributing a high cardiovascular risk was estimated by matching the categories of MetS and no-MetS with NGT and IGM. RESULTS: n=677/1397 patients (48%) satisfied criteria for MetS, while n=757/1397 (54%) had an IGM. MetS and IGM were both present in n=512/1397 patients (36.6%), and both absent in n=475/1397 (34%). Further n=410/1397 patients (29%) were discordant for the two conditions: n=165/410 (40%) had the MetS but were NGT, and n=245/410 (60%) had IGM but no MetS. Among IGM patients, n=168/757 (22%; of which 45 had no MetS) received a new diagnosis of diabetes based on OGTT criteria. Among all discordant patients, those with IGM and no MetS were more commonly males (p<0.001), and had older age (p<0.001) and lower body mass index (p<0.05). CONCLUSIONS: Among patients with hypertension, the estimate of the prevalence of diabetes and prediabetes, hence of the global cardiovascular risk, can be seriously flawed unless an OGTT is performed. Our results support a wider use of the OGTT in the management of hypertension.
