Egyptian Cirrhotic Patients Research Articles

Evaluation of The Role of Serum Epidermal Growth Factor Like Domain 7 as A New Non-Invasive Diagnostic Marker for Hepatocellular Carcinoma in Egyptian Cirrhotic Patients

Evaluation of The Role of Serum Epidermal Growth Factor Like Domain 7 as A New Non-Invasive Diagnostic Marker for Hepatocellular Carcinoma in Egyptian Cirrhotic Patients

Evaluation the Role of Lipocalin 2 as a New Non-Invasive Diagnostic Marker for Hepatocellular Carcinoma in Egyptian Cirrhotic Patients

Abstract Background Hepatocellular carcinoma (HCC) represents the sixth most common cancer worldwide. In Egypt, it represents the fourth common cancer. Significant risk factors for hepatocellular carcinoma include viral hepatitis (hepatitis B and hepatitis C), alcoholic liver disease, and non-alcoholic liver steatohepatitis/non-alcoholic fatty liver disease. HCC occurs in 80%-90% of patients with cirrhosis. The annual incidence of HCC in patients with cirrhosis is 2-4%. Aim of the Work The aim of this study is to evaluate the role of lipocalin 2 (LCN 2) as a diagnostic marker in HCC Egyptian patients. Patients and Methods A case-control study in Ain- Shams University Hospital for 6 months period and the study will be conducted on 96 Egyptian patients (32 HCC patients, 32 liver cirrhosis without HCC, 32 normal control persons). Res1ults We found that LCN 2 level ranged from 150 to 380 in HCC group with mean±SD = 292.750±50.940, from 88 to 280 in cirrhotic patients with mean± SD = 129.313±36.605, from 40 to 62 in control group with mean± SD = 53.250± 4.958, being statistically significant higher in HCC group more than both cirrhotic group and control group and in cirrhotic patients more than control group (p-value = <0.001). The results showing sensitivity of 96.87% and specificity 96.87% of LCN 2 as a marker for HCC with accuracy of 98.4%,with cut off > 160. The presence of (LCN-2) in blood and urine, in combination with α-Fetoprotein (AFP), is a biomarker of early stages of HCC. LCN 2 is a promising serum tumor marker for HCC diagnosis. Conclusion We concluded from this study that: Serum LCN 2 level was significantly higher in patients with HCC and mildly elevated in patients with liver cirrhosis compared to the control group. So it can be used as a tumor marker for HCC diagnosis. Use of LCN 2 with AFP or possibly other markers will improve the diagnostic field and can help in early detection of HCC in surveillance programms. We need further studies on large number of HCC patients of different etiologies and on metastaic liver tumors to clarify the accuracy and potential diagnostic role of LCN 2 in the future.

Role of Α-L-Fucosidase as a Diagnostic Marker versus Α-Fetoprotein in HCC Post Viral Cirrhotic Patients

Abstract Background Hepatocellular carcinoma (HCC) is the sixth most common cancer and the third cause of cancer-related mortality world- wide. The incidence of HCC is on the increase, and it is a major threat to our modern life. Epidemiological studies have indicated that HCC are related to chronic hepatitis B virus (HBV) and chronic hepatitis C virus (HCV) infection. Aim of the Work To evaluate the role of AFU as a diagnostic marker versus AFP in HCC post viral cirrhotic Egyptian patients. Patients and Methods This study had been carried out on 90 subjects, age range 21-75 year selected from Internal medicine and Hepatology outpatient clinics and inpatient wards at Ain shams university hospitals from January 2022 to June 2022. Results We found that serum levels of AFU were highest in patients of group A with HCC (129.867 ± 32.997 μl U/ml) compared to those with liver cirrhosis (33.433± 14.818 μl U/ml) with P value < 0.001 and the control groups (3.177 ± 1.199 μl U/ml) with P value < 0.001. Similarly alpha fetoprotein its serum levels were much higher in the HCC group (4688.223±11490.009 ng/ml) compared to the cirrhotic patients (4.407±3.107 ng/ml) with P value 0.02 Also, compared to healthy individuals (2.623±1.566 ng/ml) with p value 1.00. We found that there is No significant statistical correlation between serum AFP and AFU in our studied HCC and cirrhotic patients (R 0.332, P 0.073 for HCC and R 0.222, P 0.238 for cirrhotic). Regarding the negative correlation between serum AFU level and AFP level in order to predict the diagnostic value, sensitivity and specificity of both of them in term of tumor size, our study show that for AFU when the best cut off value was >52μl U/ml the sensitivity was 100% and specificity was 90% while for AFP when the best cut off value was > 10.5 ng/ml the sensitivity was 96.67% and specificity 96.67%. AFU is a promising serum tumor marker for HCC diagnosis and can be combined with AFP. Conclusion We concluded from this study that: Serum AFP was highly significant increase in HCC patients compared to cirrhotic and healthy controls, this is in agreement with many several reports that consider AFP in high serum levels as diagnostic for HCC combined with triphasic CT abdomen or dynamic MRI. Serum AFU levels were significantly higher in patients with HCC and mildly elevated in patients with liver cirrhosis compared to the control group. So it can be used as a tumor marker for HCC diagnosis. No correlation between AFU and laboratory data and child score. AFU was not influenced by clinical condition of the liver itself but with HCC. Around 40% of HCC patients have normal or low AFP level so AFU may be useful as a diagnostic marker in those patients. Serum AFP is the standard tumor marker used in clinical practice for diagnosis and surveillance of HCC in cirrhotic patients in spite of normal and low AFP HCC patients that may reach 40%. Sensitivity and specificity of AFU was nearly similar to sensitivity and specificity of AFP. Combined use of AFU with AFP or possibly other markers will improve the diagnostic field and can help in early detection of HCC in surveillance programms.

Study of the role of D-dimer in the prediction of hepatorenal syndrome in cirrhotic Egyptian patients

Study of the role of D-dimer in the prediction of hepatorenal syndrome in cirrhotic Egyptian patients

Spontaneous fungal peritonitis in cirrhotic Egyptian patients with ascites: a single-center study

Background Spontaneous bacterial peritonitis (SBP) is the most common infectious complication in cirrhosis. Spontaneous fungal peritonitis (SFP) is rare but more severe. Aim To assess the occurrence of fungal infection of the ascitic fluid in Egyptian cirrhotic patients with spontaneous peritonitis (SP) in a single-center study. Patients and methods In all, 100 patients with SP were subjected to history taking, clinical examination, laboratory investigations, abdominal ultrasonography, and diagnostic abdominal paracentesis. The ascitic fluid was subjected to microscopic examination, microbiological cultures (bacterial and fungal), biochemical examination, and 1-3-β-D-glucan. Results Of the 100 patients, 4% developed SFP and 96% developed SBP. The most common organisms in SFP patients were Candida albicans (75%), followed by Cryptococcus neoformans (25%), with no bacterial growth in those patients. Ascitic fluid bacterial culture was positive in 41.67% of patients with SBP, while it was negative in 58.33%. The most isolated organisms in SBP were Gram-negative (77.5%), predominantly E. coli (57.5%) and Klebsiella (17.5%), then Gram-positive (22.5%). Upper GI bleeding and antibiotic exposure in the last month were significantly higher in SFP than SBP. Patients with SFP had higher ascitic fluid lactate dehydrogenase 202.5 (162.5–230.0) versus 105.0 (86.0–165.0) (P=0.045) and ascitic fluid 1,3-b-d-glucan 97.95 (96.96–98.78) versus 21.0 (13.0–32.50) (P<0.001). Conclusions SFP is less common than SBP but usually presented as a severe disease, so clinical prediction and early detection help in proper treatment and a better prognosis.

The role of absolute neutrophil count, mean platelet volume and lymphocyte monocyte ratio as a simple blood markers In the diagnosis and prediction of treatment response In spontaneous bacterial peritonitis In Egyptian cirrhotic patients.

The role of absolute neutrophil count, mean platelet volume and lymphocyte monocyte ratio as a simple blood markers In the diagnosis and prediction of treatment response In spontaneous bacterial peritonitis In Egyptian cirrhotic patients.

Risks and Benefits of Propofol and Midazolam for Sedation during Upper Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients

Risks and Benefits of Propofol and Midazolam for Sedation during Upper Gastrointestinal Endoscopy in Egyptian Cirrhotic Patients

Study the Efficacy of Argon Plasma Coagulation or Endoscopic Band Ligation versus Their Companion in Management of Gastric Antral Vascular Ectasia in Cirrhotic Patients

Abstract Background Gastric antral vascular ectasia (GAVE) is a rare and often misdiagnosed cause of upper gastrointestinal bleeding accounts for up to 4% of all non-variceal upper gastrointestinal bleedings. Multiple options are available for the treatment of GAVE including endoscopic, surgical and medical therapies. Aim of the Work The aim of this study to evaluate the effect of APC followed by EBL in comparison to APC or EBL alone for the treatment of bleeding GAVE in cirrhotic patients. Patients and Methods We conducted this study on 45 adult cirrhotic patients with overt or occult bleeding from GAVE. Patients were divided into 3 groups: 15 patients in each group. Group I was treated with APC alone, group II was treated with EBL alone and Group III was treated with APC followed by EBL. Results In the current study, no statistically significant difference was detected between both groups regarding the etiology of liver cirrhosis, clinical presentation, laboratory or ultrasound findings with special emphasis on pre-treatment hemoglobin value, hospitalizations. APC alone was found to was found to be less effective in the treatment of GAVE when compared to both techniques (EBL and the combined therapy) which were effective in the treatment of GAVE and GAVE recurrence. EBL alone was found to require less number of treatment sessions but required more number of rubber bands and. Combined therapy (APC followed by EBL) successfully decreased the number of banding sessions and decreased the number of rubber bands required to treat GAVE. Conclusion Combined therapy (APC followed by EBL) and EBL alone are effective methods in the treatment of bleeding GAVE in Egyptian cirrhotic patients. EBL alone requires less number of treatment sessions but may require a big number of applied rubber bands. Combined therapy (APC followed by EBL) successfully decreased the number of banding sessions and decreased the number of rubber bands required to treat GAVE. So, in mild cases when less number of rubber bands seems to be required, it is advisable to start with EBL alone: while in severe cases where a large number of rubber bands seems to be required, it is advisable to use combination therapy of APC and EBL.

Association between Blood Ammonia Level and Severity of Portal Hypertensive Gastropathy in Egyptian Patients with Post Hepatitis C Virus Cirrhosis

Abstract Background Cirrhosis often is an indolent disease; most patients remain asymptomatic until the occurrence of decompensation, characterized by ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, or variceal bleeding from portal hypertension. In most persons, approximately 80 to 90 percent of the liver parenchyma must be destroyed before liver failure is manifested clinically. When complications of cirrhosis occur, they typically are related to impaired hepatic function or actual physical disruption and re organization of the liver parenchyma. Aim of the Work The aim of this study is to assess the correlation between blood ammonia level and severity of PHG (to determine if serum ammonia level could be used as a non invasive predictor for severity of PHG). Also, to find out if there is a causal relationship between blood ammonia level and severity of PHG which encourage trials of ammonia-lowering treatments for the management of severe PHG with a tendency to bleed) Patients and Methods This case control study was conducted upon 100 Egyptian cirrhotic patients attending at Ain Shams University Hospital (gastroenterology and hepatology department) and Kafr –El Sheikh liver center after informed written consent. Results There was a significant difference between studied groups regarding ammonia levels, with a significant increase in serum ammonia level in group 1, group 2 and group 3 versus group 4 (Pvalue ˂ 0.001). There was a significant difference between studied groups regarding haemoglobin, Platelet count, serum albumin, INR, serum bilrirubin (P-value 0.006, ˂0.001, ˂0.001, ˂0.001, ˂0.001, ˂0.001 respectively). There was a significant difference between studied groups regarding SLD (P- value ˂0.001). Splenic longitudinal diameter can be used as a good predictor for OVs. There was a significant difference between studied groups regarding PVD, portal vein flow direction and PVV (P-value ˂0.001, ˂0.001,˂0.001 respectively). There was a significant positive correlation between blood ammonia level and Child Pugh score (P 0.004), PVD (P 0.005) and SLD (P˂0.001), but ammonia has a negative correlation with PVV (P ˂0.001). There was a positive correlation between PHG score and serumammonia level (r0.830, P ˂0.001). Conclusion Blood ammonia levels correlate with the presence, severity, and score of portal hypertensive gastropathy in cirrhosis

SAT-558 - Study the effect of serum YKL-40 as a risk of variceal bleeding in Egyptian cirrhotic patients

SAT-558 - Study the effect of serum YKL-40 as a risk of variceal bleeding in Egyptian cirrhotic patients

Association between Proton Pump Inhibitors Use and Spontaneous ‎Bacterial Peritonitis Development in Egyptian Cirrhotic Patients with Ascites‎

Association between Proton Pump Inhibitors Use and Spontaneous ‎Bacterial Peritonitis Development in Egyptian Cirrhotic Patients with Ascites‎

Prevalence of arterial hypertension in liver cirrhosis and correlation with the severity of liver disease

Background and aim: Metabolic diseases and hypertension have increased dramatically in recent years, so the prevalence of hypertension in patients with cirrhosis is expected to increase. The aim of the study was to estimate the prevalence of hypertension in patients with liver cirrhosis and to determine its association with the severity of the liver disease. Patients and methods: This was a descriptive, cross-sectional, analytical study conducted at the Tropical Medicine and Infectious Diseases Department, Tanta University Hospital, Egypt. A total of 2051 patients with liver cirrhosis of various etiology were screened for participation in this study. 2014 patients were enrolled. They underwent blood pressure evaluation, blood tests and abdominal ultrasonography. Patients were classified into hypertensive and non-hypertensive groups. Results: The prevalence of arterial hypertension in patients with liver cirrhosis was 30.8%. As regards Child-Pugh class, hypertensive patients in class A were significantly increased (72.9 versus 48.7% respectively) while patients in class B and C were significantly decreased when compared with non- hypertensive patients (25.5,1.6 versus 33.29,17.93% respectively) (P <0.001). Conclusions: The prevalence of arterial hypertension in Egyptian cirrhotic patients is 30.7%, lower than that of the general population. Arterial hypertension is inversely associated with the severity of liver disease.

Fecal calprotectin level as a marker of esophageal varices in Egyptian HCV cirrhotic patients

Introduction and aimEsophageal varices are one of the complications of portal hypertension in cirrhotic patients that lead to high morbidity and mortality. Our aim was to assess the fecal calprotectin (FC) level in Egyptian cirrhotic patients as a non-invasive marker for the presence of esophageal varices. Materials and methodsThe current study included 250 participants in the period from June 2019 to November 2020, divided into three groups: group 1: 100 HCV cirrhotic patients with esophageal varices that would then be subdivided, according to the Paquet classification; group 2: 100 HCV cirrhotic patients without esophageal varices; group 3: 50 normal age and sex-matched healthy subjects as the control group. Patients with other causes of abnormal calprotectin results were excluded. ResultsThe comparison of FC in the three study groups revealed a statistically significant difference, with FC levels higher in groups 1 and 2 (mean 66.4±10.41 and 48.4±10.92, respectively). There was a significant difference in FC levels between the subgroups, subdivided according to the Paquet classification (P=.001). FC levels were higher in the grade III and IV subgroups. FC in the diagnosis of HCV cirrhotic patients with esophageal varices showed the best performance when the cut-off value was >55; AUC was 0.918, with 92% sensitivity, 95% specificity, and 93% accuracy. ConclusionFC levels serve as a screening tool for esophageal varices. FC was higher in cirrhotic patients with esophageal varices, especially in the grade III and IV subgroups, according to the Paquet classification.

El nivel de calprotectina fecal como marcador de várices esofágicas en pacientes egipcios cirróticos por VHC

Introduction and aimEsophageal varices are one of the complications of portal hypertension in cirrhotic patients that lead to high morbidity and mortality. Our aim was to assess the fecal calprotectin (FC) level in Egyptian cirrhotic patients as a non-invasive marker for the presence of esophageal varices. Materials and methodsThe current study included 250 participants in the period from June 2019 to November 2020, divided into 3 groups: group 1: 100 HCV cirrhotic patients with esophageal varices that would then be subdivided, according to the Paquet classification; group 2: 100 HCV cirrhotic patients without esophageal varices; group 3: 50 normal age and sex-matched healthy subjects as the control group. Patients with other causes of abnormal calprotectin results were excluded. ResultsThe comparison of FC in the 3 study groups revealed a statistically significant difference, with FC levels higher in groups 1 and 2 (mean 66.4±10.41 and 48.4±10.92, respectively). There was a significant difference in FC levels between the subgroups, subdivided according to the Paquet classification (P=.001). FC levels were higher in the grade III and IV subgroups. FC in the diagnosis of HCV cirrhotic patients with esophageal varices showed the best performance when the cut-off value was >55; AUC was 0.918, with 92% sensitivity, 95% specificity, and 93% accuracy. ConclusionFC levels serve as a screening tool for esophageal varices. FC was higher in cirrhotic patients with esophageal varices, especially in the grade III and IV subgroups, according to the Paquet classification.

Do old urinary biomarkers have a place in the new definition of hepatorenal syndrome in the Egyptian cirrhotic patients? A single-center experience

BackgroundHepatorenal syndrome is still a diagnosis of exclusion despite new classification.AimsTo validate the accuracy of urinary neutrophil gelatinase-associated lipocalin, interleukin-18, and kidney injury molecule-1 in the new diagnostic criteria of hepatorenal syndrome in Egyptian patients with hepatitis C virus-related liver cirrhosis using serum creatinine as a gold standard test for acute kidney injury.MethodsOne-hundred twenty cirrhotic patients with ascites were recruited and divided into two groups depending on the presence or absence of renal impairment, and 40 age- and sex-matched cirrhotic patients without ascites used as controls participated in the study. Urinary biomarkers were measured and compared with conventional biomarkers used to assess kidney function (serum creatinine, estimated glomerular filtration rate).ResultsThe mean urinary neutrophil gelatinase-associated lipocalin, interleukin-18, and kidney injury molecule-1 were statistically significantly higher in patients with hepatorenal syndrome and were found to be helpful in the early detection with cutoff values of 125 ng/ml, 34.8 pg/ml, and 3.1 pg/ml, respectively.ConclusionsUrinary neutrophil gelatinase-associated lipocalin, interleukin-18, and kidney injury molecule-1 levels are higher in patients with cirrhotic ascites complicated by HRS-AKI using the new definition of HRS, but IL-18 has lower sensitivity and specificity for the prediction of HRS-AKI as compared to NGAL and KIM-1.

Multi-detector Computed Tomography Versus Upper Gastrointestinal Endoscopy in Diagnosis and Grading of Esophageal Varices in Egyptian Cirrhotic Patients

Multi-detector Computed Tomography Versus Upper Gastrointestinal Endoscopy in Diagnosis and Grading of Esophageal Varices in Egyptian Cirrhotic Patients

Vitamin D Receptor Gene Polymorphisms and the Risk of Chronic Hepatitis C Related Hepatocellular Carcinoma in Egyptian Population

Background: Small percentage of hepatitis C (HCV) patients develop hepatocellular carcinoma (HCC) during their lifetime, suggesting that genetic factors might modulate HCC development. Numerous variations on the vitamin D receptor gene (VDR) have been recognized in human cancers. The majority of them cause VDR to be unable to bind to 1, 25-OH-D. The aim of the present work was to investigate the relation of VDR FokI (rs2228570), BsmI (rs3782905) and ApaI (rs7975232) gene polymorphisms and the risk of HCC development in chronic HCV Egyptian patients. Methods: A total of 311 Egyptian patients were enrolled for this study. They were divided into 3 groups: 103 patients with liver Cirrhosis, 107 patients with HCC and 101 normal healthy subjects as the control group. Human genomic DNA Extraction was carried out using QIAamp® DNA Blood Mini Kit (QIAGEN) Genotyping of VDR ApaI (rs7975232) single nucleotide polymorphism (SNP) was carried out using real-time PCR TaqMan allelic discrimination assay with allele-specific designed fluorescent MGB probes. Results: Patients with HCC had a higher frequency of ApaI CC genotype (P=0.035) CI (0.031-0.038). Patients with HCC carried a higher ratio of ApaI CC genotype compared to those with liver cirrhosis (x2=5.4 and P = 0.03) or controls (x2=6.8 and P = 0.01). Univariate analysis revealed that age, lower platelet count (<150×103/μL), higher AFP (>100 ng/ml), and ApaI CC genotype were the factors significantly associated with the development of HCC. Stepwise logistic regression analysis showed that all were independent predictors. Conclusion: ApaI CC VDR gene mutation is an independent risk factor for HCC development in Egyptian Cirrhotic HCV patients.

Evaluation of Serum voltage gated calcium channel α2δ1 as a novel Marker for diagnosis of Hepatocellular Carcinoma in Cirrhotic Egyptian Patient

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver tumor and represents the third-leading cause of cancer-related death in the world. The incidence of HCC continues to increase worldwide, with a unique geographic, age, and sex distribution. The most important risk factor associated with HCC is liver cirrhosis, with the majority of cases caused by chronic infection with hepatitis B (HBV) and C (HCV) viruses and alcohol abuse, although nonalcoholic fatty liver disease is emerging as an increasingly important cause. Primary prevention in the form of HBV vaccination has led to a significant decrease in HBV-related HCC, and initiation of antiviral therapy appears to reduce the incidence of HCC in patients with chronic HBV or HCV infection. Additionally, the use of ultrasonography enables the early detection of small liver tumors and forms the backbone of recommended surveillance programs for patients at high risk for the development of HCC. Cross-sectional imaging studies, including computed tomography and magnetic resonance imaging, represent further noninvasive techniques that are increasingly employed to diagnose HCC in patients with cirrhosis. The mainstay of potentially curative therapy includes surgery – either resection or liver transplantation. However, most patients are ineligible for surgery, because of either advanced disease or underlying liver dysfunction, and are managed with locoregional and/or systemic therapies. Randomized controlled trials have demonstrated a survival benefit with both local therapies, either ablation or embolization, and systemic therapy in the form of the multikinase inhibitor sorafenib. Despite this, median survival remains poor and recurrence rates significant. Further advances in our understanding of the molecular pathogenesis of HCC hold promise in improving the diagnosis and treatment of this highly lethal cancer. Objectives Evaluation of Serum voltage gated calcium channel α2δ1 as a novel Marker for diagnosis of Hepatocellular Carcinoma in Cirrhotic Egyptian Patients. Patients and Methods This study had been carried out on 90 subjects, age range 21-73 year selected from Internal medicine and Hepatology outpatient clinics and inpatient wards at Ain shams university hospitals. Subjects were divided as follow: Group A(Case): 40 patients with liver cirrhosis without Hepatocellular carcinoma and group B (Control): 40 patients with liver cirrhosis and Hepatocellular carcinoma and group C: 10 normal population for detecting normal value of the marker with exclusion criteria including age < 18 years old and Patients diagnosed with malignancy other than HCC. Results The study subjects are classified into three groups: Group A cirrhotic patients without HCC, Group B cirrhotic patients with HCC and Group C normal individual subjects. Conclusion Serum voltage gated calcium channel levels were significantly higher in patients with HCC and mildly elevated in patients with liver cirrhosis compared to the control group. Thus it can be used as a tumor marker for HCC.

Effect of rifaximin in the prevention of acute kidney injury and hepatorenal syndrome type II in Egyptian cirrhotic patients

Effect of rifaximin in the prevention of acute kidney injury and hepatorenal syndrome type II in Egyptian cirrhotic patients

Matrix Metalloproteinase-11 Gene Polymorphisms as a Risk for Hepatocellular Carcinoma Development in Egyptian Patients.

Background:Chronic hepatitis C (CHC) virus infection is one of major risk factors of hepatocellular carcinoma (HCC) in Egypt, which is a major cause of cancer mortalityin the world. Matrix metalloproteinase-11 (MMP-11) has an important role in tumor migration and metastasis. Therefore, this study aimed to determine relation between MMP-11 gene polymorphisms and risk of HCC development among Egyptian cirrhotic patients. Subjects and methods: Two hundred and sixty patients were included, 140 of them with HCC on top of CHC and 120 patients with post CHC liver cirrhosis (LC) as well as 140 subjects were enrolled in the study as healthy controls. Two single nucleotide polymorphisms (SNPs) rs738791 and rs738792 for MMP-11 gene were done using real-time PCR. Results:Combination of CT and TT allele of rs738791 genotypes was more significantly frequent in HCC compared to LC patients and controls, however, a higher frequency of T allele was found in HCC patients compared to LC and controls. In spite of lake of significant difference between patient groups regarding the rs738792 genotypes, the CC genotype was considered a risk of developing portal vein thrombosis, and was associated with advanced tumor stage, increased tumor size, higher Cancer of the Liver Italian Program [CLIP] score, more advanced Barcelona stage [D] and with child Pugh class [C]. Conclusion:Genetic variations in MMP-11 may be implicated in post HCV-HCC development and might be dependable biomarkers for HCC progression.