title: Collagen IV is a predictor for clinical course in patients with malignant obstructive jaundice.
abstract: OBJECTIVE
  Increases in the serum extracellular matrix proteins (ECMPs) have been described in studies on cholestasis, therefore we investigated the serum levels of collagen IV, aminoterminal propeptide of type III procollagen, and hyaluronic acid prior to percutaneous transhepatic biliary drainage (PTBD) to evaluate its potential as a predictor for prolonged bilirubin clearance and clinical course in patients with malignant obstructive jaundice (MOJ).
  
  
  METHODS
  Serum levels of ECMPs were prospectively investigated in 42 patients with MOJ prior to PTBD. The study group was subdivided according to the bilirubin clearance, and was also subdivided according to the determined level of collagen IV (cut-off point of 260 ng/mL).
  
  
  RESULTS
  Serum collagen IV was identified as an independent risk factor for prolonged bilirubin clearance (P=0.006). Receiver-operating-characteristic curve analysis revealed that serum collagen IV had a diagnostic accuracy of 79% at the cut-off point of 260 ng/mL. Furthermore, these results indicated that the level of collagen IV is a reliable marker of postoperative liver failure (P=0.029) and predictor of death from liver failure (P=0.02).
  
  
  CONCLUSIONS
  Elevated serum collagen IV is a feature of MOJ commonly associated with prolonged bilirubin clearance, and a useful indicator of clinical course, postoperative morbidity, and mortality in patients with MOJ.
authors.affiliation: First Department of Surgery, Nippon Medical School, Tokyo, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Shigeki
authors.initials: S
authors.lastname: Yokomuro
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Arima
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Mamada
authors.forename: Nobuhiko
authors.initials: N
authors.lastname: Taniai
authors.forename: Koho
authors.initials: K
authors.lastname: Akimaru
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
mesh_terms: D000368:Aged; D001650:Bile Duct Neoplasms / Q000097:blood*; D001663:Bilirubin / Q000097:blood; D014408:Biomarkers, Tumor / Q000097:blood*; D024141:Collagen Type IV / Q000097:blood*; D004322:Drainage; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D041781:Jaundice, Obstructive / Q000097:blood*; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood; D011183:Postoperative Complications / Q000097:blood; D011347:Procollagen / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor; D024141:Collagen Type IV; D010446:Peptide Fragments; D011347:Procollagen; C041876:procollagen Type III-N-terminal peptide; D006820:Hyaluronic Acid; D001663:Bilirubin