USE OF SERUM SOLUBLE UROKINASE PLASMINOGEN ACTIVATOR RECEPTOR TO IDENTIFY SEVERITY OF LIVER FIBROSIS AND ACTIVITY IN CHRONIC VIRAL HEPATITIS C PATIENTS

Background: identification of individuals with severe liver fibrosis among patients with chronic liver disease is of major importance when evaluating prognosis, potential risk for complications, and when deciding treatment strategies. Attempts to find reliable noninvasive markers of liver fibrosis are frequent to avoid the complications of liver biopsy. High serum concentrations of soluble urokinase plasminogen activator receptor (suPAR) are suggested to be involved in inflammation, tissue remodeling, and cancer metastasis. Objectives: To evaluate serum (suPAR) as a noninvasive biomarker to detect severity of liver fibrosis and activity in patients with chronic C hepatitis infection. Patients and Methods: 40 patients with chronic hepatitis (C) viral infection prior to treatment with antiviral combination therapy (Pegylated Interferon, Ribavirin and Sofosbuvir) were enrolled in the study.All patients were subjected to liver biopsy with assessment of serum(suPAR) levels . Result: There was significant rise in suPAR level in F4 (15.3±0.3 ng/ml ) compared to F3 (6.2±1.1 ng/ml) , F2 (4.0±1 ng/ml) and F1 (1.1±0.2 ng/ml) (P< 0.001).Also there was a significant rise in (suPAR) level in A2 (6.3±4.5 ng/ml) compared to A1 (1.1±0.2 ng/ml) (P< 0.001).There was a significant positive correlation between (suPAR) level with the stages of liver fibrosis(r=0.921, P< 0.001) and AFP (r=0.383, P< 0.018).On constructing receiver operating characteristics curve(ROC) for prediction of grade of activity, the cut-off value was ? 3.0 ng/mL can differentiate between moderate activity (A?2) and mild activity(A? 2). For prediction of different stages of liver fibrosis , it was found that cut-off value of (suPAR) for prediction of significant fibrosis F?2 was ? 2.0 ng/ml, advanced fibrosis F? 3 was ? 5.0 ng/ml, and of cirrhosis (F=4)was ?12 ng/ml. Conclusion: Serum levels suPAR can predict severity of liver fibrosis and activity in patients with chronic HCV infection