1. No conflict of interest;
RED BLOOD CELL DISTRIBUTION WIDTH (RDW)& IL1Β AS NON INVASIVE PREDICTORS OF LIVER FIBROSIS IN CHRONIC HEPATITIS C PATIENTS
GENOTYPE 4
Mahmoud El-Bendary1 , Khaled Farid1, Dina El-Barber2, Mohammed Elnagar33
1Tropical Medicine &Hepatology, Mansoura faculty of medicine 2Fever hospital, Ministry of Health, Domiatte, 3Microbiology& Immunology, Mansoura University , Mansoura, Egypt.
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Table [1]:Comparison between non invasive tests inearly fibrosis andadvanced fibrosis .
Introduction
Table[2]:ROC curve for comparison between early fibrosis & advanced fibrosis in IL1β, RDW, Platelets and RPR.
Early fibrosis
Late fibrosis
RDW
Mean±SD
113.69±2.36
18.09± 1.74 ≤
RPR
0.07± 0.02
0.11±0.02
IL1 β
CONTROL
236.14±55.85
13.40±2.72
339.88±61.94
0.0001
FIB4
Median
Minimum
Maximum
1.26
0.42
55.21
2.39
0.96
4.96
<0.001
APRI
0 .77
0.25
3.67
1.42
0.66
3.47
Area under the curve
Cutoff value
Sensitivity
Specificity
PPV
NPV
Accuracy
IL1β
90.9% (85.0%-96.8%)
294.52
86.4%
80.4%
55.8%
95.5%
82%
RDW
92.92% (87.7%-98.2%)
16.5
85.9%
63.3%
95.7%
86%
Platelets
75.0% (65.6%-84.4%)
196.5
81.8%
62.8%
38.3%
92.5%
67%
RPR
92.92,3% (87.1%-97.6%)
0.0897
90.9%
64.5%
97.1%
87%
liver biopsy is the gold standard for diagnosis of liver fibrosis but being invasive , a number of non invasive methods has been developed. Red cell distribution width(RDW) has been reported as a predictor of severity and mortality in a variety of pathological conditions including chronic hepatitis B. Interleukin-1β (IL-1β) is a potent pro-inflammatory cytokine involved in inflammation , angiogenesis and carcinogenesis.
Aims & Methods
The aim of this work is to use RDW& Interleukin-1β as a marker for non-invasive prediction of the stage of hepatic fibrosis in patients with chronic hepatitis C .100 patients with chronic hepatitis C were subjected to routine laboratory & radiological investigations in addition to using KX-21 Sysmex automated hematology analyzer to measure RDW& RPR (RDW%/Platelet ratio). Comparing with other biomarkers of liver fibrosis like APRI (AST-to-Platelet ratio index) FIB-4 equation ( using platelet count, AST, ALT, age) to perform this test. PCR HCV RNA ,genotyping & liver biopsy ( using METAVIR scoring system where cases were classified into early fibrosis (F1+F2):68 patients & late fibrosis (F3+F4) :32 patients]were done. Interleukin-1β was assayed using ELISA for all patients in addition to 20healthy subject as a control group.
In conclusion the area under the ROC curve for IL1β,RDW& RPR were excellent but for platelets, FIB-4 & APRI were fair. when applying regression analysis it was found that the RDW (OR:3.903, 95% CI : ) while IL1β (OR:1.057, 95% CI : ) & Platelets (OR:0953 , 95% CI : ), so as the level of RDW & IL1β increase by one unit the risk late fibrosis will increase by 3.9 & on the other hand when the platelets increase by one unit the risk of late fibrosis will decrease by .
By applying roc curve it was found that the cut off value of RDW was 16.5, with sensitivity 86.4 % specificity 85.9 % & accuracy 86% & the cut off value of the platelets was 196 ,5 with sensitivity 81.8 %, specificity 62.8% accuracy 67%, while RPR cut off value was with sensitivity 90.9 %, specificity 85.9 % & accuracy 87% .As regard APRI test it was found that the cut off value was 40.5with sensitivity 72.7%, specificity 66.7% & accuracy 68% While FIB-4equation showed cut off value with sensitivity 77.3 %, specificity 66.7% and accuracy 69% the cut off value of IL1β was pg/ml. with sensitivity 86.4% specificity 80.4% & accuracy 82%.
Conclusion
Results
RDW , RPR& IL1β may be used as simple, non-invasive predictors of advanced fibrosis in patients with with chronic HCV genotype-4.
RDW & RPR & IL-1β was significantly higher in patients with late fibrosis > early fibrosis (P <0.0001) while platelets count was significantly lower in late fibrosis > early fibrosis (p< 0.001).
No conflict of interest
Poster No: P: Mahmoud El-Bendary - Mansoura Faculty of Mediine - Egypt ( cell phone : c
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