Combined CTP-IGF-1 Score: A New Score for Assessment of Disease Severity in Patients With HCV-Related Liver Cirrhosis

Abstract

Background: Liver is the largest endocrine organ in the body. It is the key organ in insulin mediated metabolism, growth hormone and insulin like growth factors (IGF) pathway. Liver cirrhosis is the end result of many chronic diseases including hepatitis C virus infection. Child-Turcotte-Pugh (CTP) score is the standard used in assessment of hepatic reserve but it has its drawbacks in the form of subjective variables, hepatic encephalopathy and ascites. Objective: The work aimed to assess IGF-1 in patients with liver cirrhosis and its correlation with CTP score and to assess the value of modified combined CTP-IGF-1 score. Patients and methods: This was a case-control study that enrolled 170 patients with chronic liver disease (CLD) and 72 healthy controls. CLD (liver cirrhosis) in the study group was caused by chronic hepatitis C virus (HCV) infection. Liver cirrhosis was identified by clinical assessment, abdominal ultrasonography (US), and laboratory assessment. Results: IGF1 showed highly significant low values in the study group compared to controls (42.15 ± 27.976 and 66.31 ± 33.084 ng/ml respectively, p <0.001). The combined CTP-IGF-1 score in comparison with the classic CTP score showed improved area under curve (0.848 and 0.854), sensitivity (71.2% and 88%), negative predictive value (41.7% and 53.7%), false negative results (49 and 19) and accuracy (75.73% and 83.98%) but decreased specificity (97.22% and 61.1%), positive predictive value (99.2% and 91.5%) and higher false positive results (1 and 14) respectively. Conclusion: IGF-1 showed progressive decrements with progression of liver cirrhosis and is negatively correlated with CTP score. Addition of IGF-1 to CTP score to formulate combined score improves the AUC, negative predictive value, sensitivity, and the accuracy of CTP score and decreases the false negative results.