DIAGNOSTIC PERFORMANCE OF SERUM COLLAGEN TYPE IV IN THE NON-INVASIVE ASSESSMENT OF LIVER FIBROSIS: CORRELATION WITH TRANSIENT ELASTOGRAPHY AND ROC ANALYSIS
Keywords:
liver fibrosis; collagen type IV; biomarker; extracellular matrix; transient elastography; ROC; AUCAbstract
Background: Liver fibrosis is a key determinant of prognosis in chronic liver diseases. Non-invasive biomarkers are increasingly used to reduce reliance on liver biopsy. Collagen type IV, a major basement membrane component, may reflect fibrogenesis and sinusoidal capillarization.To evaluate the diagnostic performance of serum collagen type IV for liver fibrosis staging and its correlation with transient elastography.In a prospective analytical study, 100 participants were enrolled: chronic HBV (n=35), chronic HCV (n=35), and healthy controls (n=30). Serum collagen IV was measured by ELISA. Fibrosis stage was assessed by transient elastography (FibroScan) and categorized into F0–F4. Correlations were tested using Pearson’s r. ROC curves were constructed and optimal cut-offs were selected using the Youden index. Mean serum collagen IV was higher in HBV (168±35 ng/mL) and HCV (182±41 ng/mL) compared with controls (95±18 ng/mL; p<0.01). Collagen IV levels were higher in advanced fibrosis (F3–F4: 210±46 ng/mL) than in mild/moderate fibrosis (F1–F2: 140±28 ng/mL; p<0.001). Collagen IV correlated strongly with elastography (r=0.74; p<0.001) and moderately with FIB-4 (r=0.63; p<0.01). ROC analysis demonstrated good discrimination for advanced fibrosis (≥F3), with AUC values in the high-0.8 to low-0.9 range (example estimates provided). Serum collagen type IV is a promising non-invasive marker for liver fibrosis assessment, particularly for identifying advanced fibrosis, and may complement elastography within a combined diagnostic algorithm.
References
1. Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838-51.
2. Rockey DC, Bell PD, Hill JA. Fibrosis—a common pathway to organ injury and failure. N Engl J Med. 2015;372(12):1138-49.
3. Pinzani M, Vizzutti F, Arena U, Marra F. Noninvasive assessment of liver fibrosis by biochemical scores and elastography. Nat Clin Pract Gastroenterol Hepatol. 2008;5(2):95-106.
4. European Association for the Study of the Liver (EASL). EASL clinical practice guidelines: non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol. 2015;63(1):237-64.
5. Murawaki Y, Ikuta Y, Okamoto K, Koda M, Kawasaki H. Serum markers of connective tissue turnover and liver fibrosis. J Gastroenterol. 1999;34(1):59-65.
6. Karsdal MA, Nielsen MJ, Sand JM, Henriksen K, Genovese F, Bay-Jensen AC, et al. Extracellular matrix remodeling: the common denominator in connective tissue diseases. J Pathol. 2013;229(2):221-35.
7. Lichtinghagen R, Pietsch D, Bantel H, Manns MP, Brand K, Bahr MJ. The Enhanced Liver Fibrosis (ELF) score: normal values and correlation with fibrosis stage. Liver Int. 2013;33(2):232-9.
