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Discriminant Function Distinguishing Cirrhosis from Chronic Hepatitis

Purpose: To use the discriminant score of Fortunato et al to determine if a person with chronic viral hepatitis has progressed to cirrhosis.

Description

Fortuanto et al developed a discriminant function using 6 biochemical markers that can be used to separate patients with chronic hepatitis from those with cirrhosis. This can help monitor patients with progressive disease and can help guide use of more expensive or invasive tests. The authors are from the Universita di Napoli and Universita del Molise in Italy


 

Patients: All had chronic viral hepatitis C

 

Tests:

(1) pseudocholinesterase (PCHE) = marker of liver protein synthetic activity

(2) fibronectin = marker of fibrosis, decreased with impaired liver protein synthetic activity

(3) prothrombin activity = marker of liver protein synthetic activity

(4) ALT = marker of hepatocellular cytolysis

(5)N-acetyl-beta-glucosaminidase (beta-NAG) = marker of fibrosis associated with collagen pathways

(6) manganese superoxide dismutase (Mn-SOD) = marker of oxidative stress

 

Test

Methodology

Reference Range

PCHE

Boehringer

90 – 220 µKat/L

fibronectin

turbidometric, Roche

250 – 400 mg/L

prothrombin activity

clotting method; Organon Tecnika

70 - 120%

ALT

Boehringer

0 – 0.6 µKat/L

beta-NAG

enzymatic, Cortecs Diagnostics

µKat/L

Mn-SOD

ELISA, Bender MedSystem

35 – 114 µg/L

 

where:

• The prothrombin time increases with lower prothrombin activity.

 

discriminant score =

= (0.00011 * (pseudocholinesterase in µKat/L)) + (0.039 * (fibronectin in mg/L)) + (3.51 * LN(percent prothrombin activity)) + (0.49 * LN(ALT in µKat/L)) – (0.51 * LN(beta-NAG in µKat/L)) – (1.29 * LN(Mn-SOD in µg/L)) – 9.41

 

Interpretation:

 

Score

Diagnosis

< -0.22

cirrhosis

-0.22

indeterminate

> -0.22

chronic hepatitis

 

Performance:

• 93.7% of patients were correctly classified in an initial cohort of patients

• 85% of patients were correctly classified in a second cohort of patients

 


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Specialty

Objective

ICD-10