Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

Published on: 2010-08-19

Hyaluronic acid (HA) serum levels correlate with the histological stages of liver fibrosis in hepatitis C virus (HCV) monoinfected patients, and HA alone has shown very good diagnostic accuracy as a non-invasive assessment of fibrosis and cirrhosis. The aim of this study was to evaluate serum HA levels as a simple non-invasive diagnostic test to predict hepatic fibrosis in HIV/HCV-coinfected patients and to compare its diagnostic performance with other previously published simple non-invasive indexes consisting of routine parameters (HGM-1, HGM-2, Forns, APRI, and FIB-4).

Methods: We carried out a cross-sectional study on 201 patients who all underwent liver biopsies and had not previously received interferon therapy.

Liver fibrosis was determined via METAVIR score. The diagnostic accuracy of HA was assessed by are under the receiver operating characteristic curves (AUROCs).

Results: The distribution of liver fibrosis in our cohort was 58.2% with significant fibrosis (F[greater than or equal to]2), 31.8% with advanced fibrosis (F[greater than or equal to]3), and 11.4% with cirrhosis (F4).

Values for the AUROC of HA levels corresponding to significant fibrosis (F[greater than or equal to]2), advanced fibrosis (F[greater than or equal to]3) and cirrhosis (F4) were 0.676, 0.772, and 0.863, respectively. The AUROC values for HA were similar to those for HGM-1, HGM-2, FIB-4, APRI, and Forns indexes.

The best diagnostic accuracy of HA was found for the diagnosis of cirrhosis (F4): the value of HA at the low cut-off (1182 ng/mL) excluded cirrhosis (F4) with a negative predictive value of 99% and at the high cut-off (2400 ng/mL) confirmed cirrhosis (F4) with a positive predictive value of 55%. By utilizing these low and high cut-off points for cirrhosis, biopsies could have theoretically been avoided in 52.2% (111/201) of the patients.

Conclusions: The diagnostic accuracy of serum HA levels increases gradually with the hepatic fibrosis stage.

However, HA is better than other simple non-invasive indexes using parameters easily available in routine clinical practice only for the diagnosing of cirrhosis.

Author: Salvador ResinoJose BellonCristina AsensioDariela MicheloudPilar MirallesAna VargasPilar CatalanJuan LopezEmilio AlvarezJaime CosinRaquel LorenteMaria Munoz-FernandezJuan Berenguer

Credits/Source: BMC Infectious Diseases 2010, 10:244

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