DIAGNOSTIC-ACCURACY OF HYALURONAN AND TYPE-III PROCOLLAGEN AMINO-TERMINAL PEPTIDE SERUM ASSAYS AS MARKERS OF LIVER FIBROSIS IN CHRONIC VIRAL-HEPATITIS-C EVALUATED BY ROC CURVE ANALYSIS

Diagnostic accuracy of two serum markers of liver fibrosis, hyaluronan (HA) and amino-terminal peptide of type III procollagen (P-III-P), wa s studied in a cohort of 326 untreated patients with chronic viral hep atitis C, Both P-III-P (RIA-gnost P-III-P, Behring Diagnostic) and HA (HA-test, Pharmacia) serum concentrations correlated with the histolog ical grades of liver fibrosis (P < 0.001). Receiver-operating characte ristic (ROC) curves showed that serum HA had greater diagnostic perfor mance than P-III-P, both for discriminating patients mith extensive li ver fibrosis from those with no or mild fibrosis (area under the ROC c urves: 0.864 vs 0.691, P <0.001) or for discriminating patients with c irrhosis from those without cirrhosis (area under the ROC curves: 0.92 4 vs 0.734, P <0.001). At cutoff values of 0.8 kU/L for serum P-III-P and 85 mu g/L for serum HA, sensitivities were 70.0% and 64.5%, and sp ecificities were 63.4% and 91.2%, respectively, for discriminating pat ients with extensive liver fibrosis from those with no or mild fibrosi s. At the cutoff values of 1.0 kU/L for serum P-III-P and 110 mu g/L f or serum HA, sensitivities were 60.0% and 79.2%, and specificities wer e 74.0% and 89.4%, respectively, for discriminating patients with live r cirrhosis from those without cirrhosis. We conclude that, because th e diagnostic accuracy of serum HA is greater than that of serum P-III- P as a marker of liver fibrosis, serum HA should be preferred when mon itoring liver fibrosis in patients with chronic viral hepatitis C.