Investigation Roles of Erythropoietin, Testosterone, and Thyroid Hormones in Patients with Chronic Liver Disease

Abdulwadood Ibrahim Arif Arif; Sarmad Qassim Mohammad

doi:10.55544/jrasb.2.6.15

Authors

Abdulwadood Ibrahim Arif Department of Community Health, Technical Institute-Baquba, Middle Technical University, Diyala, IRAQ.
Sarmad Qassim Mohammad Department of Community Health, Technical Institute-Baquba, Middle Technical University, Diyala, IRAQ. https://orcid.org/0000-0002-3918-3153

DOI:

https://doi.org/10.55544/jrasb.2.6.15

Keywords:

Chronic liver disease, Erythropoietin, testosterone, thyroid function markers

Abstract

Chronic liver disease (CLD) is characterized as a steady decline in liver functions that lasts longer than six months, including the generation of clotting factors and other proteins, detoxification of toxic metabolic products, and bile excretion. CLD is a continual process of inflammation, damage, and regeneration of the liver parenchyma that results in fibrosis and cirrhosis.

The study aims to determine the predictive role of erythropoietin, testosterone, and thyroid function markers in the pathogenesis of liver dysfunction in Iraqi patients.

The current research investigation was conducted out in Baquba Teaching Hospital / Diyala governorate from November 2022 to January 2023. 50 blood samples were taken from patients who came to the Baquba Teaching Hospital and those with chronic liver disease for inspection and diagnosis by the consultant doctor in the advisory units/Baquba Teaching Hospital. 30 healthy people's blood samples were taken as a control group. The serum levels of erythropoietin, testosterone, TSH, FT3, and FT4 indicators in the samples were determined using the Roche Cobas e411.

The current study's findings revealed that 61-70 and >70 years scored highest age groups (28% and 26%) than ≤40 years that scored least age groups (6%) with significant differences (p<0.05). The levels of erythropoietin and TSH were higher in patients than healthy. In contrast, the levels of testosterone, FT3, and FT4 were low in patients than healthy with significant differences (p<0.05). According to Pearson correlations, erythropoietin is a substantial positive association with FT4 (r= 0.293* Sig.=0.039). Depending on receiver operating characteristic (ROC) curve, the present study showed the Erythropoietin, Testosterone, TSH, FT3, and FT4 markers scored the highest sensitivity (86%, 90%, 94%, 96%, and 100%) and specificity (90%, 90%, 94%, 100%, and 72%) respectively, in screening patients with Chronic liver disease (CLD).

We came to the conclusion that illness severity increased with age. Erythropoietin, testosterone, and thyroid function are good prognostic markers in screening chronic liver disease that is associated with gonadal and thyroid disorders.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

References

Hirode, G., Saab, S., & Wong, R. J. (2020). Trends in the burden of chronic liver disease among hospitalized US adults. JAMA network open, 3(4), e201997-e201997.‏

Cai, Q., Gan, C., Tang, C., Wu, H., & Gao, J. (2021). Mechanism and therapeutic opportunities of histone modifications in chronic liver disease. Frontiers in Pharmacology, 3380.‏

Cheemerla, S., & Balakrishnan, M. (2021). Global epidemiology of chronic liver disease. Clinical liver disease, 17(5), 365.‏

Xu, L., Yuan, Y., Che, Z., Tan, X., Wu, B., Wang, C., ... & Xiao, J. (2022). The hepatoprotective and hepatotoxic roles of sex and sex-related hormones. Frontiers in Immunology, 3521.‏

Estes, C., Anstee, Q. M., Arias-Loste, M. T., Bantel, H., Bellentani, S., Caballeria, J., ... & Razavi, H. (2018). Modeling nafld disease burden in china, france, germany, italy, japan, spain, united kingdom, and united states for the period 2016–2030. Journal of hepatology, 69(4), 896-904.‏

Chang, F. L., Tsai, K. C., Lin, T. Y., Chiang, C. W., Chen, W. C., Pan, S. L., & Lee, Y. C. (2022). Effectiveness of Anti-Erythropoietin Producing Hepatocellular Receptor Type-A2 Antibody in Pancreatic Cancer Treatment.‏

Bourebaba, N., Ngo, T., Śmieszek, A., Bourebaba, L., & Marycz, K. (2022). Sex hormone binding globulin as a potential drug candidate for liver-related metabolic disorders treatment. Biomedicine & Pharmacotherapy, 153, 113261.‏

Ortona, E., Pierdominici, M., & Rider, V. (2019). Sex hormones and gender differences in immune responses. Frontiers in immunology, 10, 1076.‏

Mo, M. Q., Huang, Z. C., Yang, Z. H., Liao, Y. H., Xia, N., & Pan, L. (2022). Relationship between total testosterone, sex hormone–binding globulin levels and the severity of non-alcoholic fatty liver disease in males: a meta-analysis. Therapeutic Advances in Endocrinology and Metabolism, 13, 20420188221106879.‏

Guo, W., Qin, P., Li, X. N., Wu, J., Lu, J., Zhu, W. F., ... & Zhang, Q. (2021). Free triiodothyronine is associated with hepatic steatosis and liver stiffness in euthyroid chinese adults with non-alcoholic fatty liver disease. Frontiers in Endocrinology, 12, 711956.‏

Videla, L. A., & Valenzuela, R. (2022). Perspectives in liver redox imbalance: Toxicological and pharmacological aspects underlying iron overloading, nonalcoholic fatty liver disease, and thyroid hormone action. Biofactors, 48(2), 400-415.‏

Zhang, G. X., Du, Y. J., Li, X. H., Feng, Z. T., Zhao, H., Sun, Y., ... & Li, X. J. (2018). Protective effect of erythropoietin against lipopolysaccharide induced inflammation and mitochondrial damage in liver. Journal of Biological Regulators and Homeostatic Agents, 32(2), 199-206

Radonjić, T., Dukić, M., Jovanović, I., Zdravković, M., Mandić, O., Popadić, V., ... & Branković, M. (2022). Aging of Liver in Its Different Diseases. International Journal of Molecular Sciences, 23(21), 13085.‏

Kasper, P., Tacke, F., Heppner, H. J., & Michels, G. (2022). Liver dysfunction in geriatric patients. Zeitschrift fur Gerontologie und Geriatrie.‏

Stahl, E. C., Haschak, M. J., Popovic, B., & Brown, B. N. (2018). Macrophages in the aging liver and age-related liver disease. Frontiers in immunology, 9, 2795

Zhang, X., Wong, G. L. H., Yip, T. C. F., Cheung, J. T., Tse, Y. K., Hui, V. W. K., ... & Wong, V. W. S. (2022). Risk of liver‐related events by age and diabetes duration in patients with diabetes and nonalcoholic fatty liver disease. Hepatology, 76(5), 1409-1422.‏

Sayed, M. A., Ismail, F., Mansour, Z., Mansour, O., Gomaa, A., Farag, H., ... & Ismail-Sayed, I. B. R. A. H. I. M. (2022). Chronic dyspnea on exertion in a patient with liver cirrhosis. Chest, 162(4), A2146-A2147.‏

Risør, L. M., Fenger, M., Olsen, N. V., & Møller, S. (2016). Hepatic erythropoietin response in cirrhosis. A contemporary review. Scandinavian Journal of Clinical and Laboratory Investigation, 76(3), 183-189.‏

Bhoopalan, S. V., Huang, L. J. S., & Weiss, M. J. (2020). Erythropoietin regulation of red blood cell production: From bench to bedside and back. F1000Research, 9.‏

Bothou, C., Rüschenbaum, S., Kubesch, A., Quenstedt, L., Schwarzkopf, K., Welsch, C., ... & Lange, C. M. (2020). Anemia and systemic inflammation rather than arterial circulatory dysfunction predict decompensation of liver cirrhosis. Journal of clinical medicine, 9(5), 1263.‏

Rahman, M. M., Hossain, M. L., Ali, M. H., Ullah, A. M. A., Hasan, M. R., Amit, M. N. H., & Talukder, D. K. C. (2022). Abnormal Haematological Indices in Cirrhosis in a Tertiary Care Hospital. Saudi J Med, 7(11), 555-557.‏

Gilboa, D., Haim-Ohana, Y., Deshet-Unger, N., Ben-Califa, N., Hiram-Bab, S., Reuveni, D., ... & Neumann, D. (2017). Erythropoietin enhances Kupffer cell number and activity in the challenged liver. Scientific reports, 7(1), 1-13.‏

Golmohammadi, M. G., Ajam, R., Shahbazi, A., Chinifroush-Asl, M. M., & Banaei, S. (2020). Protective effect of vitamin D3 and erythropoietin on renal ischemia/reperfusion-induced liver and kidney damage in rats. Journal of Herbmed Pharmacology, 9(3), 293-299.‏

Yang, L. J., Zhou, J. Z., Zheng, Y. F., Hu, X., He, Z. Y., Du, L. J., ... & Gu, X. J. (2023). Association of non-alcoholic fatty liver disease with total testosterone in non-overweight/obese men with type 2 diabetes mellitus. Journal of Endocrinological Investigation, 1-8.‏

Tsoris, A., & Marlar, C. A. (2022). Use of the child pugh score in liver disease.[Updated 2021 Mar 22]. StatPearls [Internet].‏

Vaishnav, B., Tambile, R., Minna, K., Addepalli, S., Wadivkar, A., Pailla, R., ... & Balem, S. (2023). Study of Gonadal Hormones in Males With Liver Cirrhosis and Its Correlation With Child-Turcotte-Pugh and Model for End-Stage Liver Disease Scores. Cureus, 15(1).‏

Dandona, P., & Rosenberg, M. T. (2010). A practical guide to male hypogonadism in the primary care setting. International journal of clinical practice, 64(6), 682-696.‏

Jensen, S. B. and Gluud, C. (1985). Sexual dysfunction in men with alcoholic liver cirrhosis. A comparative study. Liver, 5(2), 94-100.‏

Karagiannis, A., & Harsoulis, F. (2005). Gonadal dysfunction in systemic diseases. European Journal of Endocrinology, 152(4), 501-513.‏

Henze, L., Stein, S., Meyer, J., Poch, T., Krause, J., Casar, C., ... & Schramm, C. (2023). The effect of testosterone on human T cells in health and autoimmune liver disease. Zeitschrift für Gastroenterologie, 61(01), P5-31.‏

Guo, Z., Li, M., Han, B., & Qi, X. (2018). Association of non-alcoholic fatty liver disease with thyroid function: A systematic review and meta-analysis. Digestive and Liver Disease, 50(11), 1153-1162.‏

Kizivat, T., Maric, I., Mudri, D., Curcic, I. B., Primorac, D., & Smolic, M. (2020). Hypothyroidism and nonalcoholic fatty liver disease: pathophysiological associations and therapeutic implications. Journal of clinical and translational hepatology, 8(3), 347.‏

Tan, Y., Tang, X., Mu, P., Yang, Y., Li, M., Nie, Y., ... & Chen, Y. (2021). High-normal serum thyrotropin levels increased the risk of non-alcoholic fatty liver disease in euthyroid subjects with type 2 diabetes. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2841-2849.‏

Fan, H., Liu, Z., Zhang, X., Wu, S., Shi, T., Zhang, P., ... & Zhang, T. (2022). Thyroid stimulating hormone levels are associated with genetically predicted nonalcoholic fatty liver disease. The Journal of Clinical Endocrinology & Metabolism, 107(9), 2522-2529.‏

Zeng, X., Li, B., & Zou, Y. (2021). The relationship between non-alcoholic fatty liver disease and hypothyroidism: A systematic review and meta-analysis. Medicine, 100(17).‏

Tahara, K., Akahane, T., Namisaki, T., Moriya, K., Kawaratani, H., Kaji, K., ... & Yoshiji, H. (2020). Thyroid‐stimulating hormone is an independent risk factor of non‐alcoholic fatty liver disease. JGH Open, 4(3), 400-404.‏

Fröhlich, E., & Wahl, R. (2022). Insight into potential interactions of thyroid hormones, sex hormones and their stimulating hormones in the development of non-alcoholic fatty liver disease. Metabolites, 12(8), 718.