Clinical Utility of Angiotensin Converting Enzyme as a Marker of Liver Fibrosis in Budd Chiari syndrome

Abstract

Budd chiari syndrome (BCS) is a hepatic disease caused by occlusion of the hepatic venous outflow inducing chronic liver congestion and liver fibrosis. Therenin–angiotensin–aldosterone (RAS) axis is a system which involves many essential regulations in the human body for blood pressure and fluid. Angiotensin-converting enzyme (ACE), a vital part of the RAS system, was also worker as a governing molecule in systemic and portal circulation in some liverdisorders. The aim of our work was to study the clinical utility of ACE serum level as a predictor of liver fibrosis in patients with Budd Chiari syndrome (BCS). Ourstudy was conducted on 80 patients with BCS who were further subclassified according to the stage of liver fibrosis into 50 patients with stage III fibrosis and 30 patients with stage IV fibrosis;40 patientsserving as patients control group with HCV they were subclassified according to the stage of liver disease into 25 HCVpatients with stage III fibrosis and 15 HCVpatients with stage IV fibrosis. A thirdgroup of 30apparently healthy control subjects were also included. The patients will be recruited from the Tropical Medicine Department at Ain Shams University Hospitals, during the period of March 2013 till February 2014. Theresultsof the present study revealed significantly high serum ACE levels in whole BCS patients group when compared with healthycontrols. Moreover, when ACE levels in BCS patients subgroups were compared with healthy controls, statistically significant high ACE levels were observed in BCS patients .Furthermore statistically significant high ACEserum levels were observed in whole HCV patients group and its subgroup when compared with healthy control group. In the present study, statistically significant lower ACE was observed in the whole BCS patient group when compared with the whole HCV patient group. Moreover,when ACE level in BCSpatients with stage III or IV fibrosis were compared with HCV patients with the corresponding degree of liver fibrosis, statistically significant lower levelswere obtained in BCS patients. In comparing ACE level in BCS patients stage III liver fibrosis versus stage IV liver fibrosis, a statistically significant higher levels were obtained in the latter group. Likewise, higher levels of ACE levels were observed in HCV stage IV fibrosis when compared with stage III fibrosis. Moreover, ACE level showed statistically significant positive correlation with other markers of liver fibrosis (APRI and FIB4 tests). Studying the diagnostic performance of ACE levels using ROC curve analysis, in discriminating patients with whole BCS patients group from healthy control group revealed that, the best diagnostic performance of ACE levelwas at a cut-off value130 ng/mL, This level has a diagnostic sensitivity 80%, specificity of 78. 8% and efficacy 77% withAUC 0.894.While for discriminating BCS patient stage III fibrosis from healthy controls, thecut-off value 120 ng/mLwas chosen , with sensitivity of 82%,specificity of 73. 3%, and efficacy of 75% with AUC 0.928.Thediscrimination of patients with stage III fibrosis from those with stage IV fibrosis in BCS group revealed that, the best diagnostic performance of ACE levelwas at a cut-off value of 420 ng/mL. This level has a diagnostic sensitivity of 100%, specificity of 82% and efficacy of 85% with AUC 0.917.