YKL-40 and transient elastography, a powerful team to assess hepatic fibrosis

Abstract

Objective. Transient elastography (TE) is a non-invasive and accurate method for the diagnosis of severe hepatic fibrosis and cirrhosis (F = 3 and F = 4). However, the assessment of significant fibrosis (F = 2) by TE is impaired due to a high variation in the diagnostic accuracy. Within this study, we aim to compare the diagnostic value of TE and experimental biomarkers of liver fibrosis. Material and methods. A total of 55 patients with chronic liver disease of different etiologies were included in the study. Among them, patients with HCV infection represented the largest cohort (n = 25). Liver fibrosis was evaluated according to the Desmet/Scheuer score. All patients received TE. Serum concentrations of YKL-40, hyaluronic acid (HA), Laminin, C-terminal procollagen I peptide, MMP-9, TIMP-1, TIMP-2 and MMP-9/TIMP-1 complex were determined by ELISA. Results. In the total patient population, areas under the receiver operator characteristic curve (AUROC) for TE were 0.798 (F ≥ 2), 0.880 (F ≥ 3) and 1 (F = 4). Among the serum markers, highest diagnostic accuracies were calculated for YKL-40 for F ≥ 2 (0.792) and F ≥ 3 (0.914) and for YKL-40 and HA for F = 4 (both 0.936). In the subgroup of HCV patients, the following AUROCs for TE were calculated: 0.802 (F ≥ 2), 0.798 (F ≥ 3) and 0.998 (F = 4). YKL-40 exhibited the highest diagnostic accuracy of all biomarkers in the HCV population (0.880, 0.854 and 0.986, respectively). Conclusions. YKL-40 is a powerful fibrosis marker with high diagnostic accuracy, in particular in HCV-associated liver disease. Its determination may confirm and improve the diagnostic accuracy of TE especially in early stages of liver fibrosis.

Key Words::

• Biological markers
• extracellular matrix
• fibrosis
• hepatitis C
• liver cirrhosis
• matrix metalloproteinases
• transient elastography

Acknowledgments

This work was supported by grants from the Deutsche Forschungsgemeinschaft (RO 957/7-1 and RO 957/8-1) and from ZooMAP (Bundesministerium für Bildung und Forschung, BMBF). Dr. Timo Rath has received grants for young researchers (“Anschubfinanzierung”) from the Justus-Liebig-University Giessen.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.