Serum amyloid A levels in patients with liver diseases

doi:10.3748/wjg.v25.i43.6440

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Nov 21, 2019; 25(43): 6440-6450
Published online Nov 21, 2019. doi: 10.3748/wjg.v25.i43.6440

Table 1 Serum levels of serum amyloid A in different groups of subjects

Subjects (n)	mean ± SD, (mg/L)	Median (minimum-maximum), (mg/L)	Z¹ (compared with healthy controls/active CHB)	P¹ (compared with healthy controls/ active CHB)
Healthy controls (117)	2.902 ± 1.801	2.250 (0.797-9.040)	-	-
Inactive CHB (146)	2.936 ± 3.092	2.350 (0.800-29.90)	-1.129/-7.281	0.259/< 0.001
Active CHB (59)	6.621 ± 6.776	4.000 (1.700-39.90)	-5.980	< 0.001
NASH (21)	6.624 ± 4.891	5.500 (2.800-23.00)	-4.867	< 0.001
Drug-induced liver injury (14)	8.036 ± 5.685	6.800 (3.400-26.20)	-4.992	< 0.001
Autoimmune liver disease (22)	19.73 ± 24.81	13.70 (3.300-108.0)	-6.870	< 0.001
Pyogenic liver abscess (16)	398.4 ± 246.8	413.5 (62.20-871.0)	-6.474	< 0.001

¹Mann-Whitney U test was used to compare the serum amyloid A levels between various liver disease groups and the healthy control group, and Bonferroni test was applied for post hoc comparisons to control the probability of type 1 error (alpha = 0.05/6 = 0.008). CHB: Chronic hepatitis B; NASH: Nonalcoholic steatohepatitis.

Table 2 Single factor analysis of serum levels of serum amyloid A in patients with chronic hepatitis B

Factor	SAA < 6.4 mg/L	SAA ≥ 6.4 mg/L	χ²/t value¹	P¹ value	OR (95%CI)
Factor	Positive cases/total cases (%)	Positive cases/total cases (%)	χ²/t value¹	P¹ value	OR (95%CI)
Female	39/182 (21.4%)	6/23 (26.1%)	0.259	0.611	1.294 (0.478-3.503)
Age (yr)	47.87 ± 13.17	49.26 ± 14.476	-0.471	0.638	-
ALT ≥ 40 U/L	53/178 (29.8%)	7/22 (31.8%)	0.039	0.844	1.101 (0.424-2.854)
AST ≥ 35 U/L	68/178 (38.2%)	7/22 (31.8%)	0.340	0.560	0.755 (0.293-1.946)
γ-GT ≥ 45 U/L	60/178 (33.7%)	9/22 (40.9%)	0.449	0.503	1.362 (0.551-3.365)
ALP ≥ 135 U/L	12/179 (6.70%)	5/22 (22.7%)	4.592	*0.032*	4.093 (1.288-13.011)
Elevated ALP or γ-GT level	63/178 (35.4%)	10/22 (45.5%)	0.855	0.355	1.521 (0.622-3.718)
AFP ≥ 20 ng/mL	16/173 (9.2%)	3/22 (13.6%)	0.074	0.786	1.549 (0.413-5.810)
A/G ≤ 1.2	32/177 (18.1%)	7/22 (31.8%)	1.553	0.213	2.115 (0.797-5.608)
Active CHB	44/182 (24.2%)	15/23 (65.2%)	16.78	< 0.001	5.881 (2.337-14.797)
Child-Pugh grade B or C	19/182 (10.4%)	6/23 (26.1%)	3.322	0.068	1.212 (0.946-1.552)
Complicated by UGIB	5/152 (3.29%)	1/20 (5.00%)	0.000	1.000	1.547 (0.172-13.959)
Complicated by HE	4/152 (2.63%)	1/20 (5.00%)	0.000	1.000	1.947 (0.207-18.343)
Complicated by ascites	19/152 (12.5%)	6/20 (30.0%)	3.062	0.080	3.000 (1.029-8.749)
Complicated by UGIB or HE or ascites	23/152 (15.1%)	6/20 (30.0%)	1.828	0.176	2.404 (0.838-6.898)
Complicated by HCC	28/182 (15.4%)	3/23 (13.0%)	0.000	1.000	0.825 (0.230-2.963)
CRP ≥ 3 mg/L	5/35 (14.3%)	7/7 (100%)	17.01	< 0.001	6.993 (3.106-15.873)
HBsAg	160/168 (95.2%)	20/22 (90.9%)	0.121	0.728	0.500 (0.099-2.521)
HBV DNA ≥ 2000 IU/mL	43/177 (24.3%)	4/21 (19.0%)	0.285	0.593	0.733 (0.234-2.297)
Received antiviral therapy	87/162 (53.7%)	13/22 (59.1%)	0.227	0.634	1.245 (0.504-3.076)

¹Continuous normal distribution data were analyzed by the t-test to determine the difference between two groups. Enumeration data were analyzed by the chi-square test to analyze the difference between groups. ALT: Alanine transaminase; AST: Aspartate transaminase; γ-GT: γ-glutamyltransferase; ALP: Alkaline phosphatase; AFP: Alpha-fetoprotein; A/G: Albumin/globulin ratio; HCC: Hepatocellular carcinoma; CRP: C-reactive protein; UGIB: Upper gastrointestinal bleeding; HE: Hepatic encephalopathy; SAA: Serum amyloid A; CHB: Chronic hepatitis B.

Table 3 Multivariate analysis of serum levels of serum amyloid A in patients with chronic hepatitis B

Factor	Regression coefficient	P value	OR	95%CI
Active CHB	1.828	0.039	6.222	1.095-35.36

CHB: Chronic hepatitis B.

Table 4 Comparison of serum amyloid A levels between active and inactive chronic hepatitis B patients with oral antiviral therapy

Status of patients with antiviral therapy	n	mean ± SD of SAA (mg/L)	Average rank of SAA	Z¹ value	P¹ value
Active CHB	18	6.289 ± 6.042	74.92	-4.077	0.000
Inactive CHB	82	3.379 ± 4.726	44.46	-4.077	0.000

¹The Mann-Whitney U test was used to compare the serum amyloid A levels between various liver disease groups. SAA: Serum amyloid A; CHB: Chronic hepatitis B.

Table 5 Correlation of serum amyloid A and C-reactive protein levels among patients with various liver diseases

Disease	SAA (mg/L)		CRP (mg/L)		¹Spearman’s rank correlation coeffi-cient	P value
Disease	mean ± SD	Median (minimum-maximum)	mean ± SD	Median (minimum-maximum)	¹Spearman’s rank correlation coeffi-cient	P value
CHB	3.984 ± 4.743	3.250 (0.80-39.90)	4.398 ± 6.522	1.500 (0.30-25.40)	0.620	< 0.001
Autoimmune liver disease	19.73 ± 24.81	13.70 (3.30-108.0)	9.633 ± 5.977	9.100 (1.20-19.60)	0.504	0.020
Pyogenic liver abscess	398.4 ± 246.8	413.5 (62.20-871.0)	138.8 ± 57.46	141.1 (22.90-271.3)	0.508	0.045
Drug-induced liver injury	8.036 ± 1.519	6.800 (3.40-26.20)	6.490 ± 2.616	2.850 (0.30-25.30)	0.219	0.544

¹The Spearman’s rank correlation test was used to determine correlation between groups. SAA: Serum amyloid A; CRP: C-reactive protein.

Citation: Yuan ZY, Zhang XX, Wu YJ, Zeng ZP, She WM, Chen SY, Zhang YQ, Guo JS. Serum amyloid A levels in patients with liver diseases. World J Gastroenterol 2019; 25(43): 6440-6450
URL: https://www.wjgnet.com/1007-9327/full/v25/i43/6440.htm
DOI: https://dx.doi.org/10.3748/wjg.v25.i43.6440