Abstract

EVALUATION OF KALLISTATIN AS A BIOMARKER IN CHRONIC HEPATITIS C PATIENTS

Halla M. Ragab*, Fawzy A. Attaby, Nabila Abd El Maksoud, Wael Mohamed Aref, Mona A. Amin, Heba K. Abdelhakim and Wafaa Abd Elaziz*

ABSTRACT

Early outcome prediction after hepatitis C viral infections has a great interest. This study aims to evaluate kallistatin in the prediction of liver fibrosis in chronic hepatitis C Egyptian patients. This study included 62 patients with chronic HCV infection (30 patients suffering from early liver fibrosis, 16 with advanced liver fibrosis, 16 with HCC) and 14 healthy subjects. Serum liver function tests were determined by colorimetric methods, HBsAg, HCVAb, AFP, CRP and kallistatin were investigated by ELISA, HCV-RNA and the expression of SERPINA4 gene were determined by qRT-PCR assay, abdominal ultrasound and ultrasonic-guided liver biopsy were done to determine the stage of fibrosis. Serum kallistatin level was significantly lower in patients with chronic liver disease (CLD) than healthy subjects at the gene expression and protein levels (P=0.003 & 0.001, respectively). Also, there was a significant difference in kallistatin concentration in early and advanced fibrosis, (p=0.044). Serum kallistatin had greater sensitivity and NPV values than did AST/ALT ratio (AAR) and AST/platelet ratio index (APRI) in patients with CLD compared with healthy subjects with sensitivity 95.1%, specificity 50%, PPV 89.2%, and NPV 70%. Moreover, Kallistatin could significantly distinguish patients at early stage of liver fibrosis from healthy subjects with sensitivity 96.7% and specificity 50%. Compared with single detection, combined measurement of the AAR, APRI and kallistatin markers showed 90% sensitivity and 78.6% specificity, 90% PPV and 78.6% NPV. These data support that kallistatin may be an efficient biomarker in early detection of fibrosis. Also, it suggested that combination of kallistatin with AAR and APRI could improve the sensitivity and specificity for the diagnosis of CLD and this can be used as a practical method for clinical diagnosis for the early stage of liver fibrosis.

Keywords: Chronic liver disease, Kallistatin, SERPINA4, qRT-PCR, ELISA.