Evaluation of Serum Procollagen Aminoterminal Propeptide III, Laminin, and Hydroxyproline as Predictors of Severe Fibrosis in Patients with Chronic Hepatitis C

Abstract

In an attempt to identify biochemical analytes that could enhance the discrimination between the patients with severe liver fibrosis (F3‐F4) and mild fibrosis (F1‐F2) based on absolute values of biochemical markers, we measured 12 analytes, including procollagen III aminoterminal propeptide (PIIINP), laminin, proline, hydroxylproline, glycine, AST, ALT, alkaline phosphatase, albumin, total bilirubin, total protein, and prothrombin time in 252 individuals with chronic hepatitis C infection (CHC). PIIINP and laminin were determined by radio‐immunoassay; the degraded amino acids were determined using high performance liquid chromatography. Statistical analyses were performed by logistic regression, and receiver operating characteristic (ROC) curves. The best linear combination of blood markers was selected by multivariate discriminant analysis (MDA) for construction of the fibrosis discriminant score (FDS). FDS, an index of five markers (PIIINP, laminin, hydroxyproline, prothrombin activity, and AST/ALT) correctly classified 82% of the patients with severe liver fibrosis at a discriminant cut‐off score=−0.5 (i.e., less than −0.5 indicated severe liver fibrosis and greater than −0.5 indicated mild liver fibrosis with sensitivity (76%) and specificity (89%). This result was reproduced in a validation study with no significant difference. In conclusion, FDS is useful for identifying severe liver fibrosis in patients with CHC.

Keywords:

• Liver
• HCV
• Fibrosis
• Biomarkers
• Score
• Procollagen III aminoterminal propeptide

Acknowledgment

The authors would like to thank Dr. Kadry S. Gad at Faculty of Medicine, Mansoura University for his kind assistance.