Serum Vascular Endothelial Growth Factor and Insulin-Like Growth Factor-1 in Liver Cirrhosis: Relation to Disease Severity and Development of Portal Hypertension

Abstract

Aims:To assess the level of Vascular Endothelial Growth factor (VEGF) and Insulin-like Growth Factor -1(IGF-1) in serum of patients with liver cirrhosis and correlate them to Child-Pugh classes and to correlate Vascular Endothelial Growth factor to Color Doppler indices of portal and splenic veins.Patients and Methods: fifty-five patients with liver cirrhosis and ten healthy controls were chosen. They underwent a thorough history, physical examination, abdominal ultrasonography and Color Doppler examination of portal vein and portal pressure. The serum levels of VEGF and IGF-1 were measured using commercial ELISA kits.Results: The median (and interquartile range) of serum VEGF was significantly lower in patients than controls (120ng/L [110-330] and 341ng/L [258-990] respectively, p value < 0.001), also there was a significant decrease in IGF-1 in patients than controls (34ng/ml [23-48.3] and 147.2ng/ml[125.8-220.2] respectively, p value < 0.000). There was a significant difference in median serum VEGF and IGF-1 levels among the different Child-Pugh classes (class A: 110ng/L [109-120], class B: 120.5ng/L [120-462], and class C 126.5ng/L [110-286], p value < 0.005 for VEGF and class A: 48.3ng/ml [42.8-49.4], class B: 23ng/ml [20.8-34], and class C 36.6ng/ml [32.3-49.7], p value < 0.000 for IGF-1). A significant positive correlation was noted between serum VEGF and maximum portal vein velocity and maximum splenic vein velocity (Spearman's r = 0.780, r = 0.693 respectively, p value < 0.000). A significant negative correlation was noted between serum VEGF and the hepatic artery resistance index and splenic hilar diameter (Spearman's r = -0.462, r = - 0.695 respectively, p value < 0.000). Significant positive correlation was found between IGF-1 serum levels and serum albumin (Spearman's r = 0.310, p value = 0.012). No correlation was found between VEGF serum levels and serum albumin.Conclusion: Circulating VEGF level in patients with liver cirrhosis could not serve as an indicator of the progression of liver cirrhosis but rather it may reflect developmentof complication in the form of portal hypertension. Also, liver cirrhosis is associated with changes in serum IGF-1 that is related to the degree of liver dysfunction.