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Original Research

IJMDC. 2017; 1(3): 99-106

A novel score for diagnosis of liver fibrosis based on Th17 activity and sera fibrosis biomarkers

Soad Nady, Asmaa Ezz, Mohammad A. Mohey, Gamal Esmat, Wafaa Elakel, Mohammad T. Shata.


Background: Fibrosis is a major cause of morbidity and mortality worldwide. Biopsy is an invasive procedure. For the evaluation of liver fibrosis, an alternative, noninvasive, new, easy, and available method is determined to assess hepatic fibrosis in Egyptian patients.
Methodology: We enrolled 143 patients with fibrosis and they were divided into two groups, severe fibrosis and mild fibrosis group. Th17 cells were stimulated in vitro with S. mansoni soluble egg antigen (SEA), then interleukin (IL)-17, IL-22, and interferon (IFN)-γ were assessed in the culture supernatant. Serum levels of alanine aminotransferase, aspartate aminotransferase, YKL-40, and hyaluronic acid (HA) were also assessed using enzyme-linked immunosorbent assay. Analysis of individual data was conducted to characterize the diagnostic accuracy of the three highly significant fibrosis biomarkers (HA, IL-22, and IFN-γ).
Results: A highly significant difference in IL-22, IFN-γ, and HA levels between mild and severe groups was observed. Linear combination of the three biomarkers was selected by the multivariate discriminate analysis as the best combination for construction of the fibrosis discrimination equation. Application of the equation on all patients correctly classified 28.7% with severe fibrosis and 71.3% with mild fibrosis at a discriminant cut-off score (0.297) with 87.18% sensitivity and 85.57% specificity.
Conclusion: A simple fibrosis score = [0.594 (numerical constant) + 0.007 × HA (ng/ml) + 0.006 × IL-22 (ng/ml) − 0.129 × IFN-γ (pg/ml)] may be useful for discrimination of severe from mild fibrosis patients without the need of liver biopsy.

Key words: liver fibrosis, Th17 cells, sera fibrosis biomarkers

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