Prospective analysis of serum ferritin in a cohort of NAFLD related hepatocellular carcinoma

Abstract

INTRODUCTION: Non-alcoholic fatty liver disease (NAFLD) is a leading cause for hepatocellular carcinoma (HCC) in Sri Lanka. In these patients diabetes mellitus, alcohol abuse and liver inflammation are known to increase the risk of HCC. OBJECTIVES: The present study evaluates serum ferritin levels in a cohort of patients with non-viral hepatitis-HCC (nvHCC). METHOD: Consecutive patients with nvHCC, presenting to the Colombo North Liver transplant Service, Ragama, from Jan 2012 to Aug 2015 were investigated. All were negative for Hepatitis B and C. At registration, 5ml of serum was separated into plain tubes, stored at-800 C and analysed for ferritin using an enzyme-linked immunosorbent assay. Correlation between the serum ferritin and patient risk factors, liver status and tumour characteristics were analysed. RESULTS: There were 93 patients with nvHCC [median age65(12-82) years; 82(88.2%) males]. The median ferritin level was 246.2 mcg/L,and 38(40.86%) patients had elevated ferritin. Non-diabetics (median=363.5mg/L, p= 0.003), alcohol abusers (median=261.2mg/L, p= 0.018) and patients with advanced Child class (Child A=207.8mg/L, Child B=208.6mg/L, Child C 635mg/L, p= 0.045) had higher ferritin levels. On multivariate analysis being non-diabetic and an advanced Child class were significantly associated with high serum ferritin. No association was found between serum ferritin and body mass index, tumour stage, size and morphology, number of nodules and alpha fetoprotein. CONCLUSIONS: In patients with nvHCC, serum ferritin levels are higher in non-diabetics and advanced cirrhosis.