title: The Role of Ischemia Modified Albumin as a Biomarker in Patients with Chronic Liver Disease.
abstract: BACKGROUND
  Chronic Liver Disease (CLD) is characterised by gradual destruction of liver tissue over time. Ischemia Modified Albumin (IMA) is an upcoming biomarker shown to be elevated in conditions associated with ischemia and oxidative stress. Albumin levels are greatly reduced in patients with CLD and studying its alterations will provide essential information regarding the molecular changes occurring to it.
  
  
  OBJECTIVE
  The study aims to estimate IMA and IMA/Albumin ratio in patients with CLD and to correlate it with parameters assessing liver function and the Model for End Stage Liver Disease (MELD) score.
  
  
  METHODS
  The study consisted of 43 CLD patients as test subjects and 28 apparently healthy individuals as controls. Multiple parameters assessing liver function like albumin, bilirubin, aspartate transaminase (AST), alanine transaminase (ALT), Gamma Glutamyl Transpeptidase (GGT), alkaline phosphatase (ALP), Prothrombin Time (PT) INR and creatinine were estimated and the MELD score calculated. Serum IMA expressed as Absorbance Units (ABSU) was estimated using the Albumin Cobalt Binding test (ABT). Student's t-test and correlation coefficient was used for statistical analysis.
  
  
  RESULTS
  Serum IMA was significantly higher in CLD patients (0.5320 ± 0.1677) as compared to the control group (0.3203 ± 0.1257) with a p-value of <0.0001. The IMA/Albumin ratio was also significantly higher (0.2035 ± 0.0970) in patients with CLD compared to control group (0.0714 ± 0.0283) with a p-value of <0.0001. IMA has a negative correlation with albumin. The IMA/Albumin ratio shows positive correlation with MELD score, bilirubin and ALP. There was no correlation with ALT, AST, GGT and PT INR.
  
  
  CONCLUSIONS
  Decreased serum albumin correlates with increase in IMA in CLD could indicate a qualitative change and not merely a quantitative reduction of albumin. IMA can serve as a biomarker to assess the disease severity and prognosis of CLD patients.
authors.affiliation: Intern, Department of Biochemistry, PSG Institute of Medical Sciences and Research , Peelamedu, Coimbatore, India .
authors.forename: Prashanth Ashok
authors.initials: PA
authors.lastname: Kumar
authors.affiliation: Assistant Professor, Department of Biochemistry, PSG Institute of Medical Sciences and Research , Peelamedu, Coimbatore, India .
authors.forename: Kavitha
authors.initials: K
authors.lastname: Subramanian
keywords: Ischemic damage; MELD score; Oxidative stress