Assessment of Ischemia Modified Albumen in Chronic Liver Diseases

Aims: Ischemia modified albumin (IMA) level is increased in ischemic conditions and in diseases such as myocardial infarction, systemic sclerosis, advanced cancer, end-stage renal disease and intrauterine disorders. The role of IMA in chronic liver diseases and its correlation with disease severity needs further investigations. So we aimed to assess IMA and its ratio to albumin as a marker of advanced liver cirrhosis and their correlation with the disease severity.

Study Design: A cross sectional study including125 patients with chronic liver disease (80 males and 45 females) with mean age 54.63 years; and 35 healthy controls.

Place and Duration of Study: Hepatology Unit Specialized Medical Hospital and Tropical Department, Mansoura University between June 2014 and March 2015.

Methodology: The patients with chronic liver disease (80 males, 45 females) with age range from 46 to 62 years, 70 cases were chronic HCV, 15 chronic HBV, 20 combined HCV, HBV 10 autoimmune liver diseases, 5 NASH, and 5 of unknown cause. They were further subdivided according to Child-Pugh scoring into 50 patients with Child A, 45 patients with Child B and 30 patients with Child C. 35 healthy subjects of matched age and sex were included as control group. Laboratory analysis including complete blood count, liver profile, prothrombin time, IMA and IMAR were done to all patients and control.

Results: There was significant increase in IMA and IMAR in studied patient groups versus controls, in Child B versus Child A and in Child C versus both Child A & B. A significant positive correlation was found between both IMA & IMAR with total bilirubin and INR while a significant negative correlation was reported between both IMA & IMAR with albumin, ALT, AST, Hb, WBCs and PLT in liver cirrhosis. At cut off > 0.767 IMA had a sensitivity of 86.99% and a specificity of 77.1% (AUC; 0.85) and at cut off > 0.213 IMAR had a sensitivity of 92.5% and a specificity of 88.5% (AUC; 0.95) for detecting liver cirrhosis. For detecting severity of liver cirrhosis, by comparing Child B and Child C, at cut off > 0.968 IMA had a sensitivity of 93.3% and a specificity of 94.2% (AUC; 0.96) and at cut off > 0.453 IMAR had a sensitivity of 92.8% and a specificity of 72.7% (AUC; 0.86) for detecting severity of liver cirrhosis.

Conclusion: IMA and IMAR are sensitive markers in chronic liver disease and better correlated with the degree of decompensation. A further study to assess their role in follow up of treatment response is recommended.