"Cancer Antigen-125and ICAM-1Are Together Responsible For Ascites In Liver Cirrhosis"

Background-Cancer Antigen-125is a high molecular weight glycoprotein used mainly for diagnosis of ovarian carcinoma. However, elevation of Cancer Antigen-125is observed in many benign conditions especially in liver cirrhosis but the reason behind the elevation remains unknown.Similarly intercellular adhesion molecule (ICAM-1)is a90-kDa transmembrane glycoprotein and a ligand for leukocyte-function-associated antigen and its elevation is also reported in liver cirrhosis but their role played in liver cirrhosis and ascites is unclear.It has been confirmed that measurement of serum ICAM-1(sICAM-1) levelshas clinical significance in patients with chronic liverdiseases.Methods-A total of76patients were involved in the study diagnosed with liver cirrhosis, Budd-Chairi syndrome and Tuberculous Peritonitis all of whom were admitted in Department of Gastroenterology of Qilu Hospital of Shandong University.The degree of ascites was graded according to standard criteria into mild, moderate and severe. Cancer Antigen-125levels and sIC AM-1levels of all the patients were measured along with other liver parameters to evaluate the association of CA-125and sICAM-lwith ascites.The study was done in two segment; the first segment included liver cirrhosis patients only and in the second segment of this study patient of benign diseases like Budd-Chairi syndrome and Tuberculous Peritonitis was added along with liver cirrhosis patients, then all the patients were subdivided into two groups according to the presence and absence of ascites.CA-125measurements were performed through Elecsys CA125‖CalSet (Roche, Switzerland) on an Elecsys2010(Roche, Switzerland) immunoassay system using monoclonal antibodies.ICAM-1measurements were done by measuring the soluble form of intercellular adherent molecule-1(sICAM-1). Intercellular adherent molecule-1Elisa kit (Chemicon) along with Elecsys2010(Roche, Switzerland) immunoassay systemwas used for measuring sICAM-1.Results-When Cancer Antigen-125levels of liver cirrhosis patients were correlated with ascites a strong correlation was observed with degree of ascites but with liver function parameters no association was seen. When liver cirrhosis patients with ascites were compared with liver cirrhosis patients without ascites p<0.05is obtained showing significant difference. All the patients with ascites had elevated level of CA-125(mean-261.11±118.15) whereas most of the patients without ascites had CA-125levels under the normal range. A strong correlation,p<0.05is seen between CA-125level and degree of ascites. Elevated levels of sICAM-lwere observed in liver cirrhosis patients with ascites as well as in patients with other benign disease with ascites (mean sICAM-1-7.23±4.12and6.67±2.99). When s ICAM levels of liver cirrhosis patients with and without ascites were compared a significant difference that is P<0.05is observed.Conclusion-The elevation of Cancer Antigen-125in liver cirrhosis is specific to ascites. The mesothelial cells of the peritoneum chiefly contribute to the elevation of Cancer Antigen-125along with the large surface area of the peritoneum. Therefore CA-125can be used as a good marker for early diagnosis of ascites and CA-125has no relation with the etiology of diseases in benign ascites. ICAM-1plays a key role in the formation of ascites by influencing the endothelial-vascular permeability and therefore it along with CA-125can be used as a marker or alternative tool to diagnose ascites, to monitor the progression and severity of the disease.