The role of serum type IV collagen and serum procollagen type III (PIIINP) as biomarkers for the detection and staging of liver fibrosis in a sample of Iraqi patients with chronic liver disease

Background:The standard diagnostic for grading and staging hepatic fibrosis and inflammation is still a liver biopsy.However, noninvasive techniques are now favored due to several limitations of the liver biopsy.In order to measure the degree of liver fibrosis in chronic liver disorders, some research suggested using hyaluronic acid and laminin as indicators. Aim of the study:The aim of the current study was to evaluate the role of serum type IV collagen and serum procollagen type III (PIIINP) as biomarkers for the detection and staging of liver fibrosis in a sample of Iraqi patients with chronic liver disease.Patients and methods: The current case control study included 100 patients with liver fibrosis and 50 healthy control individuals of comparable age and gender.The age range of patients was from 32 to 67 years.Patients were having chronic liver disease and they were grouped into 22, 36, 19 and 23 as having alcoholic liver disease, non-alcoholic liver disease, HBV and HCV.Demographic characteristics were obtained including age, gender and body mass index.Assessment of the following biochemical testes was performed to all participants by ELISA: ALT, AST, ALP, GGT, TSB, Albumin, type IV collagen and procollagen type III (PIIINP).Results: There was significant difference in mean collagen IV among patients' and control groups (p < 0.001) in such a way that highest level was reported in patients with grade 3-4 liver fibrosis and this level was significantly higher than that of patients with liver fibrosis grade 0-1 and control group (p < 0.05) and the level of patients with liver fibrosis grade 0-1 was significantly higher than that of control group (p < 0.05).Type III Procollagen Peptide (PIIINP) level showed significant difference among control and patients' groups (p < 0.001) in such a way that the level was highest in patients with grade 3-4 liver fibrosis which was higher than both control group and patients with liver fibrosis of grade 0-1; but, there was no significant difference in its level between control group and patients with liver fibrosis of grade 0-1 (p > 0.05).Receiver operator characteristic (ROC) analysis was carried out in order to evaluate the diagnostic potential of Serum collagen IV and Type III Procollagen Peptide (PIIINP) in the detection of liver fibrosis and the results were shown in figures 1 and 2 and table 4. In terms of sensitivity, the most sensitive among markers was Collagen IV followed by PIIINP.In terms of specificity, the most specific among markers was PIINP followed by collagen IV.In terms of accuracy, the most accurate marker was Collagen IV followed by PIIINP.Receiver operator characteristic (ROC) analysis was carried out in order to evaluate The discriminative potential of Serum collagen IV and Type III Procollagen Peptide (PIIINP) in the detection of grade of liver fibrosis (grade 3-4 versus grade 0-1) and the results were shown in figures 3 and 4 and table 5.In terms of sensitivity, the most sensitive among markers was Collagen IV followed by PIIINP.In terms of specificity, the most specific among markers was PIIINP followed by Collagen IV.In terms of accuracy, the most accurate marker was PIIINP followed by Collagen IV.Conclusion: Both serum type IV collagen and serum procollagen type III (PIIINP) are markers of detecting and grading liver fibrosis in patients with chronic liver disease with clinically acceptable levels of accuracy, sensitivity and specificity and can replace liver biopsy when it is contraindicated.