This study included 170 patients with chronic HCV related liver cirrhosis and 72 healthy controls. According to CTP score; this study included 93 A, 57 B and 20 C. The demographic data of the study group in comparison to the controls showed that there was no significant difference between both groups regarding residency, occupation, smoking history, hypertension history and surgical or dental procedures. The age of the study group is older than the controls (controls 41.50 ± 10.961 years, study group 56.96 ± 6.813 years, p<0.001) and most of the cases were males (controls 50.0%, study group 72.9%, p 0.007). Diabetes mellitus (controls 0.0%, study group 28.2%, p <0.001) and history of anti-bilharzial treatment (controls 30.6% oral and 5.6% injection, study group 51.8% oral and 29.4% injection, p <0.001) were significantly higher in the study group in comparison to controls (table 3).
Regarding the laboratory investigations of the study group in comparison to controls, IGF-1 showed highly significant low values in the study group in comparison to controls (42.15 27.976 and 66.31 33.084 ng/ml, respectively, p 0.001). Other laboratory investigations showed significantly lower haemoglobin (12.25 ± 1.792, 13.32 ± 1.649, p 0.001), platelets (115.12 ± 66.981, 215.19 ± 60.221, p value <0.001), serum albumin (3.26 ± 0.615, 4.37 ± 0.458, p <0.001) in the study group in comparison to controls in a respective manner and significantly higher white blood cells (6.38 ± 12.816, 6.13 ± 1.816, p 0.015), random blood glucose (127.08 ± 54.142, 97.97 ± 14.812, p 0.001), AST (74.51 ± 39.585, 50.03 ± 31.661, 0 <0.001), serum bilirubin (1.88 ± 1.679, 0.78 ± 0.247, p <0.001), INR (1.25 ± 0.220, 1.07 ± 0.095, p <0.001) and alpha feto protein (356.34 ± 1093.41, 4.85 ± 6.04, p <0.001) in the study group in comparison to controls in a respective manner (Table 4).
Assessment of the levels of IGF-1 in relation to CTP score in the study group showed that IGF1 levels were 48.32 ± 28.611, 40.28 ± 25.869 and 18.80 ± 15.953 ng/ml (mean ± standard deviation) in relation to CTP score groups A, B and C respectively (p value < 0.001) (Table 4).
Correlation between IGF-1 and CTP score in the study group using Spearman correlation coefficient revealed that there is highly significant negative correlation between IGF-1 and CTP score in the study group (p < 0.001) (Table 5).
Comparison of IGF-1, CTP score and combined CTP-IGF-1 score in differentiating normal liver in one hand from liver cirrhosis in the other hand showed that the area under the curve was 0.718, 0.848 and 0.854, and the diagnostic point was 55.5 ng/ml, 5.5 and 4.5, sensitivity 71.2%, 72.2% and 88.8%, specificity 61.1%, 97.22% and 91.5%, negative predictive value 31.0%, 41.7% and 53.7%, and accuracy 69.42%, 75.73% and 83.98% for IGF-1, CTP-IGF-1 score respectively (Table 7 and figure 1).
Table 3
Demographic characteristics and medical history of the studied patients in comparison to controls
|
Control group (n= 72)
|
Study group (n= 170)
|
95% CI
|
p
|
Age (years)
|
49.50 ± 10.961
|
53.96 ± 6.813
|
- 19.3, - 11.6
|
0.061
|
Gender
|
Male
|
50.0% (36)
|
72.9% (124)
|
0.05, 0.41
|
0.007
|
Female
|
50.0% (36)
|
27.1% (46)
|
Residency
|
Rural
|
94.4% (68)
|
97.1% (165)
|
-0.05, 0.11
|
0.608
|
Urban
|
5.6% (4)
|
2.9% (5)
|
Occupation
|
Employee
|
13.9% (10)
|
25.9% (44)
|
-
|
0.131
|
Housewife
|
41.7% (30)
|
27.1% (46)
|
Manual worker
|
44.4% (32)
|
47.1% (80)
|
Smoking
|
No
|
66.7% (48)
|
70.4% (119)
|
-
|
0.835
|
Smoker
|
27.8% (20)
|
26.0% (44)
|
Ex-smoker
|
5.6% (4)
|
3.6% (6)
|
History of DM
|
0% (0)
|
28.2% (48)
|
0.22, 0.35
|
˂ 0.001
|
History of HTN
|
8.3% (6)
|
14.1% (24)
|
-0.05, 0.16
|
0.428
|
History of Operation
|
44.4% (28)
|
53.5% (91)
|
-0.03, 0.32
|
0.322
|
History of Dental
|
72.2% (52)
|
75.3% (128)
|
-0.13, 0.19
|
0.700
|
History of Anti-bilharzial
|
None
|
63.9% (46)
|
18.8% (32)
|
-
|
˂ 0.001
|
Oral
|
30.6% (22)
|
51.8% (88)
|
Injection
|
5.6% (4)
|
29.4% (50)
|
Data is expressed as mean and standard deviation or as percentage and frequency. 95% CI: 95% confidence interval of the mean difference between both groups. P is significant when ˂ 0.05.
|
Table 4
laboratory investigations of the studied patients in comparison to controls
|
Control group (n= 72)
|
Study group
(n= 170)
|
95% CI
|
P
|
Hb
|
13.32 ± 1.649
|
12.25 ± 1.792
|
0.45, 1.68
|
0.001
|
WBCs
|
6.13 ± 1.816
|
6.38 ± 12.816
|
-2.29, 1.77
|
0.015
|
Platelets
|
215.19 ± 60.221
|
115.12 ± 66.981
|
77.47, 122.67
|
˂ 0.001
|
Creatinine
|
0.84 ± 0.117
|
0.96 ± 0.535
|
-0.21, -0.03
|
0.064
|
RBS
|
97.97 ± 14.812
|
127.08 ± 54.142
|
-38.80, -19.41
|
0.001
|
IGF1 (ng/ml)
|
66.31 ± 33.084
|
42.15 ± 27.976
|
12.24, 36.06
|
˂ 0.001
|
ALT
|
58.40 ± 50.082
|
55.88 ± 30.115
|
-14.98, 20.02
|
0.291
|
AST
|
50.03 ± 31.661
|
74.51 ± 39.585
|
-36.69, -12.29
|
˂ 0.001
|
Albumin
|
4.37 ± 0.458
|
3.26 ± 0.615
|
0.94, 1.30
|
˂ 0.001
|
Bilirubin
|
0.78 ± 0.247
|
1.88 ± 1.679
|
-1.36, -0.83
|
˂ 0.001
|
INR
|
1.07 ± 0.095
|
1.25 ± 0.220
|
-0.23, -0.13
|
˂ 0.001
|
AFP
|
4.85 ± 6.04
|
356.34 ± 1093.41
|
-517.05, -185.93
|
˂ 0.001
|
Data is expressed as mean and standard deviation or as percentage and frequency. 95% CI: 95% confidence interval of the mean difference between both groups. P is significant when ˂ 0.05, Hb: hemoglobin, WBCs: white blood cells, RBS: random blood sugar, IGF1: insulin like growth factor 1, ALT: alanine transaminase, AST: aspartate transaminase, INR: international normalized ratio, AFP: alpha feto protein.
|
Table 5
Assessment of IGF-1 levels in study group based on CTP score groups
|
CTP A (n= 93)
|
CTP B (n= 57)
|
CTP C (n= 20)
|
P
|
IGF1 (ng/ml)
|
48.32 ± 28.611
|
40.28 ± 25.869
|
18.80 ± 15.953
|
˂ 0.001
|
Data is expressed as mean and standard deviation. P is significant when ˂ 0.05, CTP: Child Turcot Pugh score, IGF1: insulin like growth factor-1
|
Table 6
correlation between IGF-1 and CTP score
|
Spearman correlation coefficient
|
P
|
IGF-1 and CTP score
|
-0.318
|
˂ 0.001
|
P is significant when ˂ 0.05, IGF1: insulin like growth factor-1, CTP: Child Turcot Pugh score
|
Table 7: Comparison between IGF-1, CTP score and their combination in evaluation of liver cirrhosis.
|
IGF-1
|
CTP score
|
Combined
|
Area Under Curve
|
0.718
|
0.848
|
0.854
|
Diagnostic point
|
55.50
|
5.5
|
4.5
|
Sensitivity
|
71.2%
|
71.2%
|
88.8%
|
Specificity
|
61.1%
|
97.22%
|
61.1%
|
Positive Predictive Value
|
89.6%
|
99.2%
|
91.5%
|
Negative Predictive Value
|
31.0%
|
41.7%
|
53.7%
|
False positive
|
14
|
1
|
14
|
False negative
|
49
|
49
|
19
|
Accuracy
|
69.42%
|
75.73%
|
83.98%
|
IGF1: Insulin like growth factor-1, CTP: Child Turcot Pugh Score
|