Table 1: Characteristics of published studies that investigated the diagnostic value of serum activin-A ± follistatin in patients with chronic hepatitis C (CHC).

Research groupPublication yearStudy designNumber of patientsHCV genotypeSerum target markersMain findingsReference number

Patella et al.2001Retrospective15 normal control  
22 CHB  
47 CHC
Not reportedActivin-A  
Follistatin
Significant increase in serum activin-A in viral hepatitis (B and C) but not serum follistatin 
No correlation between serum activin-A and follistatin with viral load and liver enzymes
[128]

ElSammak et al.2006Prospective case-control30 normal control  
30 Hepatitis C  
30 CHC + SHF  
30 CHC + HCC
Not reportedActivin-ASerum activin-A increased significantly in the study groups compared to control and it was the highest in HCC 
Serum activin-A correlated positively with the Child-Pugh scoring in the study groups
[127]

Voumvouraki et al.2012Prospective case-control19 normal control  
47 primary biliary cirrhosis  
22 alcoholic cirrhosis  
16 alcoholic fatty liver  
18 CHC  
20 CHC + cirrhosis  
39 HCC
Not reportedActivin-ANo significant difference for serum activin-A in patients with activin CHC compared with control either in peripheral of portal vein samples
There was no correlation between the cirrhosis stage and activin-A levels
[129]

Refaat et al. (a)2014Prospective case-control40 normal control  
40 CHC
Genotypes 1 and 4Activin-A  
Activin-B  
Follistatin
Serum activin-A and activin-B significantly increased, while serum follistatin significantly decreased in CHC 
It was positive for activin-A and activin-B with viral load, APRI, IL-6, and TNF-α and negative with albumin  
No correlation was detected for follistatin
[1]

Refaat et al. (b)2014Prospective cross-sectional40 normal control  
33 CHC + no treatment  
19 CHC at week 4 of therapy  
22 CHC at week 12 of therapy  
19 CHC at week 24 of therapy  
21 responder to therapy  
11 nonresponder to therapy
Genotypes 1 and 4Activin-A  
Activin-B  
Follistatin
Serum activin-A and activin-B significantly increased, while serum follistatin significantly decreased in CHC  
Activin-A and follistatin, but not activin-B, at weeks 4, 12, and 24 after treatment initiation were similar to normal control  
Activin-A correlated positively and significantly with the viral load and APRI
[2]

CHB: chronic hepatitis B; SHF: schistosomal hepatic fibrosis; HCC: hepatocellular carcinoma; APRI: AST platelet ratio index.