Cutoff values of protein induced by vitamin K absence or antagonist II for diagnosing hepatocellular carcinoma

Abstract

Protein induced by vitamin K absence or antagonist II (PIVKA-II) is a promising serum marker for hepatocellular carcinoma (HCC). There are limited data on its cutoff value in HCC for Taiwanese cirrhosis patients. This study aimed to investigate the diagnostic value of PIVKA-II levels in patients with suspected HCC. In total, 88 patients with chronic hepatitis and suspected HCC by ultrasound, elevated α-fetoprotein (AFP) or PIVKA-II levels were consecutively enrolled. Their baseline characteristics and findings on dynamic phases of computed tomography (CT) or magnetic resonance imaging (MRI) were examined. Sixty participants had cirrhosis and 34 had HCC. The median levels of PIVKA-II in non-cirrhosis and cirrhosis patients without or with HCC were 28.0, 48.0, and 847.0 mAU/mL, respectively. The optimal cutoff value of PIVKA-II in predicting HCC was 78.0 mAU/mL. Combining AFP with PIVKAII mildly increased its diagnostic performance for HCC, yielding higher specificity and positive predictive value. Significant factors predicting HCC in multivariate regression analysis were PIVKA > 78.0 mAU/mL and fatty liver. Monitoring PIVKA-II level is suitable for noninvasively assessing HCC in patients with chronic hepatitis, particularly with AFP.

Reference Range of Vitamin K Evaluating Indicators in Chinese Childbearing Women

“…Ko et al established a reference interval (13.00-37.40 mAU/mL) based on 204 healthy individuals, which is between the Japanese range (11.12-32.01 mAU/mL) and the European range (17.36-50.90 mAU/mL) in the product package insert [27], and the upper limit of these ranges is higher than ours. In addition to indicating subclinical vitamin K deficiency, PIVKA-II can serve as a biomarker of hepatocellular carcinoma (HCC) with cut-off values well above our reference range [30,42]. The results obtained may vary with the selection of different detection assays and kits.…”