Enhanced liver fibrosis test in a group of patients with alcohol abuse
Abstract
Background: Enhanced Liver Fibrosis (ELF) test is a set of indirect markers of liver fibrosis that can be used for the assessment of the severity of liver fibrosis. ELF test includes three biomarkers: hyaluronic acid (a component of the extracellular matrix), TIMP-1 (an inhibitor of matrix metalloproteinases that break down collagen) and PIIINP (a marker of collagen synthesis at the site of disease process). These biomarkers or ELF test can be used in early diagnostic approaches of liver damage caused by viral infections or alcohol abuse. The main aim of our study was measuring ELF values in three groups of individuals: a control group, a group of alcoholics and a group of patients with acute alcohol intoxication. The results of ELF test were compared with established biochemical markers of alcoholism.
Methods: In the study 113 individuals (71 males, 42 females) with a mean age of 43 years were included. They were divided into three groups: OSM group consisted of individuals (N = 39) who were seen in the Occupational and Sports Medicine Clinic. The AAI group consisted of 31 individuals with acute alcohol intoxication, and the AD group consisted of 43 individuals who were undergoing treatment for alcohol dependence. We assessed the following parameters in the serum samples of all three groups of subjects: mean corpuscular volume (MCV), activity of aspartate amino transferase (AST), alanine amino transferase (ALT), gama glutamyl transferase (GGT) and the parameters of novel ELF test for liver fibrosis stage assessment. ELF values are below 7.7 in the early stage of fibrotic process and above 9.8 in severe fibrosis. All statistical tests were conducted by SPSS 21.0 for Windows (SPSS, Inc. Chicago, USA).
Results: Mean values of the established biomarkers of alcoholism in OSM, AAI and AD groups for MCV were 91.9; 90.9 in 95.3, medianes of catalitic activity of AST were 0.30; 033 in 0.42 µkat/L, for ALT 0.41; 0.34 in 0.56 µkat/L and for GGT 0.37; 0.34 in 0.92 µkat/L. Kruskal – Walliss test showed a statistical significance between groups for AST, GGT in MCV (p < 0.002), while ALT (p = 0.052) did not differ significantly. In OSM mediane ELF test is 7.99 (6.99–10.18), and in AD group 9.47 (6.98–14.73). In AD group a statistically significant correlation was between AST, ALT, GGT and ELF test (r = 0.524; 0.306 in 0.632), in OSM the significance was proved only for MCV (r = 0.327).
Conclusion: The results of the measurements show a statistically significant increase in the established markers of alcoholism (MCV, AST, ALT and GGT) in the AD group as compared to the OSM group. Median ELF test in the AD group indicates moderate liver fibrosis, however, considering the range of 6.98 to 14.73, some individuals in this group have severe fibrosis. The results show that increased values of AST, ALT and GGT and correlations between them indicate liver damage, while ELF test better predicts developing stage of liver fibrosis. Various scores and indexes are used for liver fibrosis assessment. ELF test is proposed as a very useful diagnostic test and probably has a high potential of aplicability in the primary care of patients with alcoholic and nonalcoholic liver damage.
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