Comparison of conventional noninvasive tests and natural anticoagulants in assessment of liver fibrosis stage.

Objectives: Primary aim To assess the performance of selected natural anticoagulants suing liver biopsy as the gold standard. Secondary aim Compare performance of natural anticoagulants with traditional noninvasive methods We did study of Haemostatic Factors (ONLY) as Biomarkers of Significant Liver Fibrosis in Patients with Chronic Hepatitis C ( see below abstract) . We found it a negative study and challenged to be published. So we did reanalysis and included the results of fibroscn and other noninvasive score APRI, FIB-4 AND AST/ALT ratio and we want rewrite it after combining all these markers and score. Importance: most of the studies in hematologic factors in liver disease did not assess liver fibrosis in large biopsy study….most studies for hematology assess this in cirrhotic ( but not patient with less degree of fibrosis) What is needed: To write the manuscript with new objective and including noninvasive scores and fibroscan in addition to the hemostatic factors Rearrange and include tables Update and included relevant references Professional writing --------- ABSTRACT Background & Aims Hemostatic factors are affected in chronic liver disease (CLD). Evidence regarding their use as noninvasive markers of CLD severity is scarce. We aimed to study the association between the levels of hemostatic factors and the severity of liver fibrosis in a large cohort of chronic HCV patients. Methods A cross sectional study was conducted on 402 adults with HCV. Liver biopsy and blood tests including platelet count, prothrombin time, international normalized ratio (INR), thrombin time (TT), antithrombin (AT), reptilase time (RT), fibrinogen, factor VII, protein C (PC), protein S(PS), free protein S, and C4 binding protein (C4BP) were performed. Variables significantly associated with significant (≥F2, Metavir) fibrosis on univariate analysis were included in a multivariate logistic regression model. Results Of the 402 eligible participants, 377 patients were included in the analysis. Significant fibrosis was present in 37.4%. INR increased while AT and PC decreased with increase in fibrosis stage (p value for all <0.001). C4BP levels reduction was associated with significant (≥F2) fibrosis (OR, 0.98; 95% CI: 0.97-0.99) adjusting for other parameters at multivariable analysis, so that as C4BP increases by one point, odds of having ≥F2 fibrosis decreases by 2%. Conclusions This study demonstrates a close relationship between hemostatic factors and histologic fibrosis progression in a large cohort of HCV patients. C4BP has the strongest association and could be used as a potential noninvasive marker of liver fibrosis. Further studies to validate this association are needed.