Research

Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus

Philippe Halfon¹ , Marc Bourlière² , Guillaume Pénaranda¹ , Romaric Deydier¹ , Christophe Renou³ , Danielle Botta-Fridlund⁴ , Albert Tran⁵ , Isabelle Portal⁴ , Isabelle Allemand⁴ , Alessandra Rosenthal-Allieri⁵ and Denis Ouzan⁶

¹Department of virology, Alphabio Laboratory, Marseille, France

²Department of Hepato-Gastroenterology, Saint-Joseh Hospital, Marseille, France

³Department of Hepato-Gastroenterology, Hyères Hospital, Hyères, France

⁴Department of Hepato-Gastroenterology, La Conception Hospital, Marseille, France

⁵Department of Hepato-Gastroenterology, Archet Hospital, Nice, France

⁶Department of Hepato-Gastroenterology, Arnault Tzanck Institute, Saint Laurent du Var, France

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Comparative Hepatology 2005, 4:6doi:10.1186/1476-5926-4-6

Published:	11 July 2005

Abstract

Background

In patients with chronic hepatitis C virus, liver biopsy is the gold standard for assessing liver disease stage; nevertheless, it is prone to complications, some of them serious. Non-invasive methods have been proposed as surrogate markers for liver fibrosis. It was shown that serum hyaluronic acid (HA) level increases with the development for liver fibrosis. The aim of this study was to evaluate the diagnostic value of HA as well as to determine the HA level cut-off for predicting the presence or absence of fibrosis, severe fibrosis, and cirrhosis.

Results

405 patients with chronic hepatitis C were prospectively included with biomarker measurement and liver biopsy done the same day: 151 in the training set (only biopsy lengths of 25 mm or more) and 254 in the validation set. For the discrimination of significant fibrosis, severe fibrosis, and cirrhosis in the training set, the areas under curve (AUCs) were 0.75 ± 0.03, 0.82 ± 0.02, and 0.89 ± 0.03, respectively. Absence of significant fibrosis, severe fibrosis, and cirrhosis can be predicted by HA levels of 16, 25, and 50 μg/l, respectively (with negative predictive values of 82%, 89%, and 100%, in the same order). Presence of significant fibrosis, severe fibrosis, and cirrhosis can be predicted by HA levels of 121, 160, and 237 μg/l, respectively (with positive predictive values of 94%, 100%, and 57%, in the same order).

Conclusion

In the validation set, HA was accurate in predicting significant fibrosis, severe fibrosis, and cirrhosis with AUCs of 0.73, 0.77, and 0.97, respectively. Moreover, accurate HA level cut-offs were defined for predicting significant fibrosis, severe fibrosis, and cirrhosis. Thus, the study supports that HA level may be clinically useful as a non-invasive marker for liver fibrosis and/or cirrhosis.