Measurement of serum hyaluronic acid in patients with chronic hepatitis C and its relationship to liver histology

Background and Aims: Chronic hepatitis C is a slowly progressing inflammato ry disease of the liver that can lead to cirrhosis and its complications. A ssessment of liver damage in hepatitis C has been primarily via histologica l evaluation. Liver biopsy, while useful in determining the extent of liver damage, has associated costs and places patients at a small but finite ris k of bleeding. Studies in small patient populations have identified serum m arkers shown to correlate with liver histology, including procollogen III p eptide and hyaluronic acid (HA). To determine whether serum HA was a reliab le predictor of cirrhosis and fibrosis, we examined serum HA concentrations from 486 chronic Hepatitis C virus (HCV) patients. Methods and Results: Patients were anti-HCV and HCV RNA positive, with elev ated alanine aminotransferase values and underwent a liver biopsy. Sera wer e obtained at the baseline for HA using radioimmunoassay methodology. Patie nts with cirrhosis had significantly higher serum HA concentrations compare d with non-cirrhotic patients (382+/-31 vs 110 +/- 9 mu g/L, respectively, P < 0.001). Patients with fibrosis had significantly higher mean serum HA c oncentrations (179 +/- 11 mu g/L) compared with patients without fibrosis ( 62 +/- 20 mu g/L; P < 0.001). The correlation between HA concentration and the components of the Knodell histological activity index score revealed no strong associations with the exception of fibrosis, which showed moderate correlation (R = 0.5421, P < 0.001). The clinical value of HA measurement a ppears to be its ability to exclude cirrhosis. A HA value of < 60 mu g/L ex cluded the presence of cirrhosis or significant fibrosis with a predictive value of 99 and 93%, respectively. Conclusions: Serum HA measurement may be clinically useful to non-invasivel y assess the degree of fibrosis and cirrhosis. Further prospective studies are warranted to determine the clinical utility of HA as a non-invasive mar ker of liver fibrosis. (C) 2000 Blackwell Science Asia Pry Ltd.