Gut Liver.  2015 Mar;9(2):224-230. 10.5009/gnl14047.

The Influence of Alcoholic Liver Disease on Serum PIVKA-II Levels in Patients without Hepatocellular Carcinoma

• Kang K
• Kim JH
• Kang SH
• Lee BJ
• Seo YS
• Yim HJ
• Yeon JE
• Park JJ
• Kim JS
• Bak YT
• Byun KS

• KMID: 2380768
• DOI: http://doi.org/10.5009/gnl14047

Abstract

BACKGROUND/AIMS
Prothrombin induced by vitamin K deficiency or antagonist II (PIVKA-II) is a widely used diagnostic marker for hepatocellular carcinoma (HCC). We evaluated the correlation between alcoholic liver disease (ALD) and serum PIVKA-II levels in chronic liver disease (CLD) patients.
METHODS
We retrospectively reviewed the medical records of 2,528 CLD patients without HCC. Among these patients, 76 exhibited serum high PIVKA-II levels of >125 mAU/mL (group 1). We categorized 76 control patients matched by age, sex, and the presence of liver cirrhosis from the remaining patients who were negative for serum PIVKA-II (group 2).
RESULTS
Group 1 revealed increased antibiotic usage (23.7% vs 2.6%, p<0.001) and incidence of ALD (60.5% vs 14.5%, p<0.001) as well as elevated aspartate aminotransferase (52.5 IU/L vs 30.5 IU/L, p=0.025) and gamma glutamyl transpeptidase (67.5 IU/L vs 36.5 IU/L, p=0.005) levels compared with group 2. Further, group 1 was significantly associated with a worse Child-Pugh class than group 2. In the multivariate analysis, ALD (odds ratio [OR], 7.151; p<0.001) and antibiotic usage (OR, 5.846; p<0.001) were significantly associated with positive PIVKA-II levels.
CONCLUSIONS
Our study suggests that ALD and antibiotics usage may be confounding factors when interpreting high serum PIVKA-II levels in patients without HCC. Therefore, serum PIVKA-II levels in patients with ALD or in patients administered antibiotics should be interpreted with caution.

Keyword

Prothrombin induced by vitamin K deficiency or antagonist II; Liver diseases, alcoholic; Hepatocellular carcinoma

MeSH Terms

Adult
Age Distribution
Aged
Anti-Bacterial Agents/therapeutic use
Aspartate Aminotransferases/blood
Biomarkers/*blood
Carcinoma, Hepatocellular/blood
Diagnosis, Differential
Female
Humans
Liver Cirrhosis/blood
Liver Diseases, Alcoholic/*blood
Liver Neoplasms/blood
Male
Matched-Pair Analysis
Middle Aged
Multivariate Analysis
Protein Precursors/*blood
Prothrombin/analysis
Retrospective Studies
Sex Distribution
gamma-Glutamyltransferase/blood
Anti-Bacterial Agents
Aspartate Aminotransferases
Biomarkers
Protein Precursors
Prothrombin
gamma-Glutamyltransferase