Combined CTP- IGF-1 Score: A New Score for Assessment of Disease Severity in HCV Related Liver Cirrhosis

Background: Liver is the largest endocrine organ in the body. It is a key organ in insulin mediated metabolism, growth hormone and insulin like growth factors (IGF) pathway. Liver cirrhosis is the end result of many chronic diseases including hepatitis C virus infection. Child-Turcotte-Pugh (CTP) score is the standard used in assessment of hepatic reserve but it has its drawbacks in the form of subjective variables, hepatic encephalopathy and ascites. The aim of this work is to assess IGF-1 in patients with liver cirrhosis, correlate it with CTP score and assess value of modified combined CTP-IGF-1 score. Patients and Methods: 170 patients with CLD (liver cirrhosis) and 72 healthy controls in the study groups were enrolled in the study. All patients were subjected to thorough history, clinical examination and laboratory assessment. IGF-1 was measured and all patients were evaluated using CTP and CTP-IGF-1 scores. Results: IGF1 showed highly significant low values in the study group in comparison to controls (42.15 ± 27.976 and 66.31 ± 33.084 ng/ml respectively, p <0.001). It showed also highly significant negative correlation to CTP score in the study group (p < 0.001) with progressive decrements with CTP score stage progression where IGF1 levels were 48.32 ± 28.611, 40.28 ± 25.869 and 18.80 ± 15.953 ng/ml (mean ± standard deviation) in relation to CTP score groups A, B and C respectively (p value < 0.001). The combined CTP-IGF-1 score in comparison to the classic CTP score showed improved area under curve (0.848 and 0.854), sensitivity (71.2% and 88%), negative predictive value (41.7% and 53.7%), false negative results (49 and 19) and accuracy (75.73% and 83.98%) but decreased specificity (97.22% and 61.1%), positive predictive value (99.2% and 91.5%) and higher false positive results (1 and 14) respectively. Conclusion: IGF-1 show progressive decrements with progression of liver cirrhosis and is negatively correlated with CTP score. Addition of IGF-1 to CTP score to formulate combined score improves the AUC, sensitivity, negative predictive value and the accuracy of CTP score and decreases the false negative results.