| ORIGINAL ARTICLE
|Year : 2022 | Volume
| Issue : 2 | Page : 227-235
Serum matrix metalloproteinase 7 as a diagnostic and prognostic biomarker for extrahepatic biliary atresia
Teg Rabab Singh1, Prabudh Goel1, Minu Bajpai1, Devasenathipathy Kandasamy2, Rohan Malik3, Rajni Yadav4, Shyam Prakash5, Kalaivani Mani6, Madhavi Tripathi7, Devendra Kumar Yadav1, Anjan Kumar Dhua1, Vishesh Jain1, Sandeep Agarwala1
1 Department of Paediatric Surgery, All India Institute of Medicine Sciences, New Delhi, India
2 Department of Radiodiagnosis, All India Institute of Medicine Sciences, New Delhi, India
3 Department of Paediatrics, All India Institute of Medicine Sciences, New Delhi, India
4 Department of Pathology, All India Institute of Medicine Sciences, New Delhi, India
5 Department of Laboratory Medicine, All India Institute of Medicine Sciences, New Delhi, India
6 Department of Biostatistics, All India Institute of Medicine Sciences, New Delhi, India
7 Department of Nuclear Medicine, All India Institute of Medicine Sciences, New Delhi, India
Background: Differentiation of neonatal cholestasis into neonatal hepatitis (NH) and extrahepatic biliary atresia (EHBA) is essential to formulate the treatment plan; promptness is indispensable for optimal outcomes. The clinical and nonoperative algorithms lack precision; the gold standard investigations (liver biopsy or per-operative cholangiogram) are invasive. There is a need for a noninvasive test which is both, sensitive and specific and has a high likelihood ratio.
Aim: To study the (diagnostic) role of matrix metalloproteinase 7 (MMP-7) as a serum biomarker to differentiate between EHBA and NH and evaluate the prognostic significance in EHBA based on its correlation with liver histopathology and serological predictors of liver fibrosis – Aspartate-to-Platelet Ratio Index (APRI) and Fibrosis-4 (FIB-4).
Materials and Methods: This was a prospective study conducted upon patients of neonatal cholestasis presenting with acholic stools (n = 46) with equal number of controls (n = 45) with no liver pathology. Observational parametric included disease-specific workup and serum MMP-7 levels (all participants); liver biopsyl and APRI-FIB-4 (EHBA).
Results: (Diagnostic) Serum MMP-7 levels were significantly elevated in EHBA (n = 25; 28 ng/mL) as compared to those in NH (n = 21; 1.88 ng/mL) and normal infants (n = 45; 1.2 ng/mL) (P < 0.001 for both). Serum cutoff at 4.99 ng/mL differentiated EHBA-NH with a high sensitivity (96%), specificity (90.5%), and a negative predictive value (95%), with the number needed to misdiagnose being 23. (Prognostic) Inflammatory activity and fibrosis-stage on liver histopathology (METAVIR-and-Ishak scores) correlated with MMP-7 levels. APRI and FIB-4 scores also depicted a strong correlation with each other, age of the patient, and liver fibrosis.
Conclusions: MMP-7 has a diagnostic value in differentiating EHBA from NH and may also be used as a prognostic biomarker in the follow-up of these patients. MMP-7 levels in controls may be used as a baseline for future studies.
Dr. Prabudh Goel
Room No. 4002, 4th Floor, Teaching Block, Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi - 110 029
Source of Support: None, Conflict of Interest: None
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