Prognostic value of serum hyaluronan in patients with compensated HCV cirrhosis

Background/Aim: Serum hyaluronan (HA) levels increase according to the degr ee of liver fibrosis in patients with chronic viral hepatitis C. Patients w ith liver disease and markedly high serum HA levels have cirrhosis with typ ical signs of hepatic sinusoidal capillarization, a factor of aggravation o f cirrhosis. The aim of this study was to evaluate the prognostic value of serum HA for severe complications in asymptomatic patients with HCV cirrhos is. Methods: Six hundred and sixty-eight patients with anti-HCV antibodies and increased serum alanine aminotransferase were referred to our hospital for evaluation, including liver biopsy. At entry, serum HA levels were measured in 91 patients (64 men, 27 women, 56+/-11 years old) out of 103 who had as ymptomatic, biopsy-proven cirrhosis. According to the criteria of Child-Pug h, 82 were classified A and 9 B. The follow-up period was 6 to 82 months (m edian: 38 months), and 51 of these patients received alpha-interferon thera py during the first year. Severe comlplications were defined as death or li ver transplantation, ascites, bleeding from esophageal varices, encephalopa thy, or hepatocellular carcinoma. Results: Serum HA levels at entry were higher in the cirrhotic patients in whom severe complications occurred during the follow-up period (520+/-426 m u g/l vs. 197+/-146 mu g/l, p<0.0001). The patients with serum hyaluronan l evels >350 mu g/l displayed higher probabilities of occurrence of severe co mplications (p<0.0001). Other factors associated with the occurrence of com plications or death were: serum bilirubin >18 mu mol/l (p=0.03), platelet c ount <112x10(9)/l (p=0.02), prothrombin time <63% (p<0.0001), serum albumin <36 g/l (p=0.002), alkaline phosphatase >81 IU/l (p=0.01), and no interfer on treatment (p=0.0003). Multivariate analysis identified five independent factors predictive of severe clinical complications, namely: hyaluronan (p= 0.006), prothrombin time (p=0.04), bilirubin (p=0.04), albumin (p=0.04), an d no therapy (p=0.03). Conclusion: Serum HA level is predictive for occurrence of severe complicat ions in HCV cirrhosis, and can be used as a prognostic marker, in addition to the parameters of the Child-Pugh score, particularly in patients with co mpensated cirrhosis.