Serum C-reactive protein: a non-invasive marker of alcoholic hepatitis.
OBJECTIVE
To determine the diagnostic accuracy of C-reactive protein (CRP) for alcoholic hepatitis in heavy drinkers.


METHODS
A total of 101 heavy drinkers (67 M, 34 F) with elevated transaminase activity and negative HBsAg, anti-HCV and anti-HIV antibodies were included in the study. All patients underwent standard liver function tests, CRP determination and liver biopsies. None of the patients had signs of infection or inflammatory disease and none of them were taking antibiotics. The severity of alcoholic hepatitis was assessed semi-quantitatively using a Metavir-derived scoring system. The receiver operating curve (ROC) for CRP was constructed to assess different areas under the curve (AUCs) and the best threshold value for predicting alcoholic hepatitis (an AUC of 1.0 for an ideal test and of 0.5 for a less indicative test).


RESULTS
Pathological signs of alcoholic hepatitis were found in 29 patients (30%) and significant fibrosis (F > 1) in 46 (45.1%). CRP increased significantly with the severity of acute alcoholic hepatitis (p<0.001). Total bilirubin (OR = 1.03 CI 95% (1.01-1.06), p=0.04) and CRP (OR = 1.1 CI 95% (1.02-1.19), p=0.01) were independent factors for predicting alcoholic hepatitis. The area under the ROC curve of CRP was 0.78. Using optimized cut-off values (CRP > 19 mg/L), the sensitivity, specificity, positive, negative predictive value and diagnostic accuracy were 41%, 99%, 92%, 81% and 82%, respectively.


CONCLUSIONS
CRP is an accurate marker of alcoholic hepatitis.
Vanbiervliet
Geoffroy
G
Liver Unit, Hôpital L'Archet 2, Nice, France. geovbv@club-internet.fr
Le Breton
Frédèrique
F
Rosenthal-Allieri
Maria-Alessandra
MA
Gelsi
Eve
E
Marine-Barjoan
Eugenia
E
Anty
Rodolphe
R
Piche
Thierry
T
Benzaken
Sylvia
S
Saint-Paul
Marie-Christine
MC
Huet
Pierre-Michel
PM
Tran
Albert
A
D001663:Bilirubin / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006519:Hepatitis, Alcoholic / Q000097:blood*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
D015415:Biomarkers; D002097:C-Reactive Protein; D001663:Bilirubin