Summary of the demographic data of the patients
In total 381 patients were included in the study. The demographic data including age, gender and BMI were significantly different in the HCV group. Majority of the patients in the HCV group were female (56.8%). Furthermore, patients in The HCV group had significantly older than the other groups [57.5(23-79) years]. Median BMI in the HCV group was 25.7 (18-36) kg/m2 which was higher than the other groups. MELD scores did not significantly change among the study groups. HBV, HBV+HDV and cryptogenic liver failure groups were comparable in terms of patient demographic. All the demographic data and MELD scores of the patients are summarized in Table 1.
The changes in the level of the tumor markers according to the etiology of the liver failure
AFP levels were elevated in only 5.3% of the patients with cryptogenic liver failure which was significantly lower than the other groups (p=0.0001). CEA levels were elevated in 54.5% of the patients with HCV related liver failure which was higher than other study groups (p=0.0001). Ca19-9 elevation was present in 68.2% of the patients with HCV related liver failure which was higher than the other study groups (p=0.001). Other than these results there were no significant changes among the serum tumor markers in the other study groups. The percentage of the patients with elevated serum tumor levels among the study groups are summarized in Table 1.
Elevation of the tumor markers according to the MELD scores of the patients
The median MELD scores of the patients in the study was 17. The patients were grouped in to two groups according to their MELD scores. Patients with MELD scores ≤20 constituted 76% of the patients (n=290). The percentage of the patients with elevated serum tumor marker levels were evaluated among these two groups in order to study the effect of increasing MELD scores. The percentage of the patients with elevated Ca 125 were elevated with increasing MELD scores (62.4% versus 74.7%, p=0.03). Percentage of patients with elevated Ca19-9 significantly increased with increasing MELD scores (45.2% versus 59.3%, p=0.02). Frequency of Ca 15-3 significantly increased with increasing MELD scores (36.6% versus 45.9%, p=0.03). Other tumor markers did not change significantly with the MELD scores. All results regarding the elevation of the tumor markers according to MELD scores are summarized in Table 2.
Table 2
Evaluation of the serum tumor markers according to the MELD score of the patients.
| MELD≤20 (n=290) | MELD >20 (n=91) | P Value |
AFP elevation (% of patients) | 20% | 20.9% | 0.86 |
CEA elevation (% of patients) | 27.2% | 34.1% | 0.210 |
Ca125 elevation (% of patients) | 62.4% | 74.7% | 0.031a |
Ca 19-9 elevation (% of patients) | 45.2% | 59.3% | 0.02b |
Ca 15-3 elevation (% of patients) | 36.6% | 45.9% | 0.03c |
The tumor markers are expressed of percentage of the patients with elevated serum level (i.e. serum value greater than the upper limit of the normal range). |
MELD= Model for End Stage Liver DiseaseAFP: Alfa Feto Protein, CEA: Carcino-Embryonic Antigen, Ca 125: Carbohydrate Antigen 125, Ca 19-9: Carbohydrate Antigen 19-9, Ca 15-3: Carbohydrate Antigen 15-3. |
a) Ca 125 levels we significantly higher in the patients with MELD score>20 |
b) Ca19-9 levels were significantly higher in the patients with MELD scores>20 |
c) Ca 15-3 levels were significantly higher in the patients with MELD scores>20 |
Factors determining the tumor marker elevation in the study groups
The factors determining the AFP elevation in HBV group was age (CC:8.3, CI: 95%, p=0.004) and MELD scores of the patients (CC:8.6, CI: 95%, p=0.0003).
CEA elevation in the HBV group showed a linear correlation with the age of the patient (CC:8.6, CI: 95%, p=0.003).
Ca19-19 in the HBV group showed linear correlation with age (CC:7.2, CI:95%, p=0.007) and MELD scores (CC:5.4, CI:95%, p=0.02) of the patients. In HCV group Ca19-9 levels showed a linear correlation with the BMI of the patients (CC:4.4, CI:95%, p=0.04).
Ca 125 levels showed a linear correlation with age (CC:8.2, CI:95%, p=0.004) and MELD scores (CC:4.5, CI:95%, p=0.03) of the patients in the HBV group.In cryptogenic liver failure group Ca 125 levels showed linear correlation with the age (CC:5.2, CI:95%, p=0.02) and MELD scores (CC:4.5, CI:95%, p=0.03) of the patients.
Ca 153 levels were significantly correlated with MELD scores (CC:4.3, CI:95%, p=0.04) in HBV group and age (CC:3.9, CI:95%, P=0.) in the cryptogenic liver failure.