Diagnostic value of non-invasive biomarkers for stage-specific diagnosis of hepatic fibrosis in patients with advanced schistosomiasis japonica

Hepatic fibrosis caused by schistosome infection can be fatal. Its management depends on the degree of fibrosis present. To assess the diagnostic value of bio-markers in patients with advanced schistosomiasis japonica at different stages of disease progression, 84 advanced schistosomiasis japonica patients and nine controls were recruited in The People's Republic of China. Fibrosis was histologically assessed in wedge liver biopsies using the Chinese criteria for fibrosis (F) Stages. Seven selected hepatic fibrosis bio-markers were assessed and compared between the groups. The method of area under receiver operating characteristic curves (AUROCs) was used as a measurement of diagnostic efficacy. Our results showed that routine laboratory test results were normal for the controls but were significantly elevated or decreased in patients with fibrosis. While serum hyaluronic acid (HA) and matrix metalloproteinase (TIMP)-1 levels were shown to be elevated in patient groups compared with controls, the levels of platelet derived growth factor (PDGF)-BB were markedly lower. To distinguish F ≥ 2 from no fibrosis or mild fibrosis, HA gave a high AUROC of 0.938 (95% confidence interval (CI), 0.886-0.990). Combining the aspartate aminotransferase (AST) to platelet ratio index (APRI) and HA/100 showed an AUROC of 0.958 (95% CI, 0.914-1.000). APRI in combination with TIMP-1/100 provided an AUROC of 0.873 (95% CI, 0.805-0.942) for the diagnosis of fibrosis stages greater than 2. We conclude that AST and APRI levels were reliable and sensitive markers for differentiating significant hepatic fibrosis in patients with advanced schistosomiasis japonica. HA and TIMP-1 show potential as additional markers for the diagnosis of fibrosis and cirrhosis in advanced schistosomiasis patients. © 2010 Australian Society for Parasitology Inc