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    Kallistatin: diagnostic value of the new biomarker in patients with non-alcoholic fatty liver disease and hypertension
    (Maltepe Üniversitesi, 2021) Rozhdestvenska, Anastasiia
    Background: The prevalence of nonalcoholic fatty liver disease (NAFLD) ranges from 17% to 46% worldwide. Searching for non-invasive diagnostics of the NAFLD severity becomes a central issue, especially, in patients with NAFLD and arterial hypertension (HT). Kallistatin is an endogenous protein, an inflammation inhibitor, which is predicted to play an important protective role in the NAFLD progression. The aim of the study: To determine the role of kallistatin as a diagnostic biomarker of NAFLD progression in patients with concomitant HT. Materials and methods: 115 patients with NAFLD in non-alcoholic steatohepatitis (NASH) stage were divided into two groups: 63 patients with NAFLD and HT and 52 patients with isolated NAFLD. The control group consisted of 20 relatively healthy volunteers. Anthropometric parameters were obtained using standard methods. Plasma kallistatin levels were measured using the Human SERPINA4 (Kallistatin) ELISA Kit (Elabscience, USA). The level of C-reactive protein (CRP) was determined using the hs-CRP ELISA Kit (Biomerica USA). The data was statistically processed using standart PC-programmes. Results: The kallistatin level in patients with NAFLD and HT was 65.98 ng/ml (95% CI 62.85; 69.12). It was respectively in 1.3 (p < 0.001) and 1.7 times (p < 0.001) less, than in isolated NAFLD (83.42 ng/ml (95% CI 81.89; 84.94)) and control group (111.70 ng/ml (95% CI 106.14; 113.22)). Kallistatin levels were decreased in patients with increasing body mass index (BMI) both in the group with NAFLD and HT (r = -0.58; p < 0.001) and in the group with isolated NAFLD (r = 0.54; p = 0.002). The activity of kallistatin decreased with the progression of HT in patients with NAFLD (p < 0.001). The highest CRP value was found in the NAFLD and HT group (7.90mg/l (95% CI 7.96; 8.75) versus 6.55 mg/l (95% CI 6.47; 7.57) and 2.07 mg/l (95% CI 1.83; 2.85) in the isolated NAFLD and control group, respectively. The correlations between kallistatin and CRP were very strong (r = -0.89) and strong (r = -0.61) in groups with comorbid and isolated NAFLD, respectively. Conclusion: The significant decrease in kallistatin levels in patients with NAFLD was found. Concomitant HT, higher BP grade, increased BMI and high CRP levels are associated with significantly more pronounced deviations of this indicator. The obtained data provide the possibility to consider kallistatin as a biomarker of NAFLD progression, in particular, in patients with NAFLD and HT.