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PIVKA-II AS A MARKER OF CHRONIC LIVER DISEASE SEVERITY

Matea Majerović 1, Dragana Segulja 1, Ivana Lapic 1, Anamarija Bogic 1, Ivana Knezevic Stromar 1, Dunja Rogic 1, Rajko Ostojic 1, Zeljko Krznaric 1

Affiliations

1 University Hospital Centre Zagreb, Zagreb, Croatia

Summary

AI Generated

A study of 69 patients with chronic liver disease without malignancy found that PIVKA-II concentrations were significantly elevated beyond manufacturer cut-offs in benign disease, particularly in decompensated cirrhosis, and correlated with disease severity markers.

PIVKA-II concentrations were significantly higher in decompensated cirrhosis (median 245 μg/L) compared to compensated cirrhosis (median 35.1 μg/L) and no fibrosis (median 25.6 μg/L), with P=0.0008, using the Elecsys assay with manufacturer cut-off of 31.2 μg/L
Statistically significant correlations were found between PIVKA-II and total bilirubin (ρ=0.576, P=0.0001), INR (ρ=0.471, P=0.0019), and MELD-Na score (ρ=0.483, P=0.0155)
The authors conclude that elevated PIVKA-II concentrations well beyond manufacturer cut-offs may occur in benign liver disease, with higher levels expected in more severe chronic liver disease
Clinicians using PIVKA-II for hepatocellular carcinoma screening should be aware that chronic liver disease severity influences PIVKA-II levels independent of malignancy

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Protein Induced by Vitamin K Absence or Antagonist-II (PIVKA-II) is regarded as a diagnostic marker for hepatocellular carcinoma (HCC). However, the optimal cut-off level for HCC diagnosis is not precisely defined, and it depends on the assay used as well as on the etiology and the stage of the underlying liver disease.^1,2

Aims & Methods

The aim of this study was to assess PIVKA-II levels in patients with different stages of chronic liver disease without signs of malignancy. Laboratory data of 69 patients were analyzed (69.5% male, median age 58 years). The serum PIVKA-II concentrations were determined using the Elecsys PIVKA-II immunoassay (Roche Diagnostics, Mannheim, Germany). The cut-off level set by the manufacturer was <31.2 μg /L. Patients were divided into three groups: decompensated cirrhosis (N=24), compensated cirrhosis (N=20), no signs of liver fibrosis (N=25). Kruskal-Wallis test with post-hoc analysis was used to compare the groups. Correlations between PIVKA-II levels, bilirubin, INR and MELD-Na score were described by Spearman`s rank correlation coefficients (ρ). The values P ≤ 0.05 were considered statistically significant.

Results

Concentrations of PIVKA-II were significantly higher in patients with decompensated cirrhosis (median 245 μg/L, IQR 102.5-485.5) when compared to patients with compensated cirrhosis (median 35.1 μg /L, IQR 17.4-342) and patients without signs of liver fibrosis (median 25.6 μg /L, 17.2-110) (P=0.0008). A statistically significant correlation was found between the concentrations of PIVKA-II and total bilirubin (ρ = 0.576 (95% CI: 0.326-0.750), P=0.0001), INR (ρ = 0.471 (95% CI:0.191-0.680), P=0.0019) and calculated MELD-Na score (ρ = 0.483 (95% CI:0.205-0.688), P=0.0155).

Conclusion

Elevated PIVKA-II concentrations, well beyond the cut-off levels proposed by the manufacturer, may be seen in benign liver disease. Correlations with bilirubin, INR and MELD-Na suggest that higher PIVKA-II concentrations can be expected in more severe forms of chronic liver disease.

References

Kim DY, Toan BN, Tan CK, Hasan I, Setiawan L, Yu ML et al. Utility of Combining PIVKA-II and AFP in the Surveillance and Monitoring of Hepatocellular Carcinoma in the Asia-Pacific Region. Clin Mol Hepatol. 2023 Jan 30.
Qian XJ, Wen ZM, Huang XM, Feng HJ, Lin SS, Liu YN et al. Better performance of PIVKA-II for detecting hepatocellular carcinoma in patients with chronic liver disease with normal total bilirubin. World J Gastroenterol. 2023 Feb 28;29(8):1359-1373.

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Abstract

Session

PP 07 Liver & biliary (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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