Effects of eating on plasma hyaluronan in patients with cirrhosis: Its mechanism and influence on clinical interpretation

Circulating levels of hyaluronan (HA) may be a clinically useful non-invasi ve test in liver disease to evaluate, for example, the degree of fibrosis o r cirrhosis. Healthy: subjects exhibit a two-fold or greater postprandial e levation of plasma HA. We undertook this work to determine the effect of ea ting on plasma HA in patients with cirrhosis, to define mechanisms underlyi ng the changes observed and to examine whether using fasting samples improv es the discriminating value of plasma HA as a clinical test. Plasma HA was measured using a protein-binding assay in serial samples obtained over 2.5 h, during which a 2100 kJ meal and/or intravenous infusion of octreotide (2 5 mu g stat, 25 mu g/h) were given, or in paired random and fasting samples from patients with cirrhosis. In six patients with Pugh's A cirrhosis, pla sma HA increased more than two-fold after food ingestion, peaking after 75- 90 min. In four patients (one Pugh's A), no response was observed. Octreoti de transiently increased plasma HA by a mean of 20%, but, in combination wi th eating, reduced the peak plasma HA by 80% in responding patients. In 30 patients with cirrhosis, random plasma Hh was abnormal in only 70% compared with 93% of autologous fasting samples, using the respective normal ranges (P = 0.01). Ingestion of food markedly increased plasma HA in patients wit h compensated but not decompensated cirrhosis, most likely due to a postpra ndial increase in splanchnic blood flow Easting patients prior to taking bl ood improves the clinical discriminating value of plasma KA.