This study aimed to evaluate the diagnostic value of α-1-acid glycoprotein (AGP) and C-reactive protein (CRP) and develop a predictive score to improve the diagnosis of hepatocellular carcinoma (HCC). AGP and CRP were measured in serum of 53 HCC patients and 20 liver cirrhosis (LC) patients, in addition to 15 healthy individuals. Area under receiver-operating characteristic curves (AUCs) was used to create a predictive score comprising AGP, CRP, alpha fetoprotein, and albumin. The diagnostic performances of score was determined and compared with AFP alone for the diagnosis of HCC. The combination of AGP, albumin, CRP, and AFP had AUC 0.92 and sensitivity 85% which was higher than AFP alone. The odds ratio of having HCC was 8.4 for AGP, 5.8 for CRP, 12.5 for AFP and 6.5 for albumin. Our score predicted HCC with an OR of 50.6 for HCC. The AUC of score in HCC with single tumor, absent vascular invasion and CLIP score (0-1) were 0.9, 0.9, 0.82, respectively, compared with 0.71, 0.71, 0.68, respectively, for AFP. In conclusion, a non-invasive and simple score based on AGP, CRP, AFP, and albumin could improve the accuracy of HCC diagnosis.

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The incidence of hepatocellular carcinoma (HCC) and HCC-related deaths has increased over the last few decades. There are several risk factors of HCC such as viral hepatitis (B, C), cirrhosis, tobacco and alcohol use, aflatoxin-contaminated food, pesticides, diabetes, obesity, nonalcoholic fatty liver disease (NAFLD), and metabolic and genetic diseases. Diagnosis of HCC is based on different methods such as imaging ultrasonography (US), multiphasic enhanced computed tomography (CT), magnetic resonance imaging (MRI), and several diagnostic biomarkers. In this review, we examine the epidemiology of HCC worldwide and in Egypt as well as risk factors associated with the development of HCC and, finally, provide the updated diagnostic biomarkers for the diagnosis of HCC, particularly in the early stages of HCC. Several biomarkers are considered to diagnose HCC, including downregulated or upregulated protein markers secreted during HCC development, circulating nucleic acids or cells, metabolites, and the promising, recently identified biomarkers based on quantitative proteomics through the isobaric tags for relative and absolute quantitation (iTRAQ). In addition, a diagnostic model used to improve the sensitivity of combined biomarkers for the diagnosis of early HCC is discussed.

Introduction: Identification of HCV- induced liver fibrosis is mandatory for tailoring therapy, and management of complications. The current study evaluated the accuracy of circulating miRNAs; in diagnosis of hepatic fibrosis. Patients  and methods: Seventy HCV patients were subjected to routine laboratory investigations, HCV-RNA, serum miRNA-122, 221, 192, 224 , 375, and 885  by PCR, liver biopsy and calculation of the following scores:  aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR), aspartate to platelet ratio index (APRI), FIB-4 score,  Hui index,  Fibrosis Index (FI), Fibro-Q ,  Fibro-Alfa Biotechnology Research Center (BRC) score and  Gotebörg University Cirrhosis Index (GUCI). Results: Patients with significant and advanced fibrosis have significantly lower miR-122 (P < 0.0001 and P= 0.007, respectively).  miR-122, bilirubin and miR-855 were found to be  independent predictors of significant fibrosis in univariate analysis. A novel score; Cairo University Fibrosis Index (CUFI) based on microRNA 122, bilirubin and microRNA 855 were formulated for predicting significant liver fibrosis. The AUC of this score, for predicting significant and advanced hepatic fibrosis was 0.83 and 0.80 respectively.  This AUC was higher than those of other fibrosis scores. Conclusion: Cairo University Fibrosis Index is better than the existing scores in assessing fibrosis in chronic HCV patients.