الفهرس 
Chronic Liver DiseaseOnly 14 pages are availabe for public view
 |  | from | 164 |  |  |
| | | from | 164 | | |
Abstract
C
hronic liver diseases (CLD) and its end-stages, cirrhosis and hepatocelluler carcinoma, are leading causes of morbidity and mortality worldwide with enormous socioeconomic costs.
The aim of this work was to study serum level of N- terminal pro C- type natriuretic peptide in chronic liver disease patients with and without ascites in a trial to evaluate its clinical utility as a non-invasive marker of chronic liver disease complications and disease progression.
This study was conducted on 66 patients with CLD and 15 healthy controls in Ain Shams University Hospital. Subjects were further divided into 33 patients with no evidence of ascites nor liver cirrhosis by ultrasonography and 33 patients with established ascites &cirrhosis.
The results of the current study showed that routine liver function tests including ALP, AST, bilirubin and AFP were higher with disease progression and with complications namely encephalopathy and hematemesis. The same is applied for hematological findings including TLC, hemoglobin and platelets they were significantly lower in diseased group versus control whereas PT was higher among diseased groups.
NT pro CNP levels were statistically and significantly increased among ascitic group when compared to non ascitic and control groups. When comparing the marker among ascitic patients with and without encephalopathy, a statistically significant increase in NT pro CNP was noticed and its value was doubled among patients with encephalopathy, compared to those without encephalopathy. Likewise when NT pro CNP levels were compared among ascitic patients with and without hematemesis, a statistically highly significant increase in NT pro CNP was noticed among patients with hematemesis, compared to those without hematemesis.
A significant positive correlation was found between the marker values and AFP in group II whereas it was not significantly correlated with the other studied laboratory parameters. Moreover, NT- pro CNP show a significant positive correlation with serum creatinine in group I.
Moreover, a statistically significant difference was observed in the marker levels among esophageal varcies stages 1, 2, 3, with significant stepwise elevated levels from stage 1compared to stage 2 and stage 3.
ROC analysis for assessment of the diagnostic performace of NT- proCNP for discriminating healthy controls versus chronic liver diseased patients was done. The best cut-off value was 85 ng/L with AUC of 0.803 sensitivity, specificity and accuracy of 84.8%, 53.3% and 79%; respectively. We were the first till present to investigate the diagnostic performance of NT-proCNP in discriminating non ascitic patients from controls with best cut-off 85ng/L, sensitivity, specificity and accuracy of 75.8%, 533% and 68.6% respectively. Also the marker could discriminate between ascitic patients and those free from ascites with best cut-off 105ng/L, sensitivity, specificity and accuracy of 72.7%, 54.5%, and 63.6% respectively.
At a cut-off level of 175ng/L, NT-proCNP achieved 100% accuracy in discriminating ascitic patients with hematemesis or encephalopathy from those without, with the marker being doubled in these affected groups
In conclusion, an increased level of NT-pro CNP is a promising non-invasive marker of CLD complications and disease progression.