Serum hyaluronan - a non-invasive test for diagnosing liver cirrhosis

Introduction Hyaluronan is a glucosaminoglycan synthesized by the mesenchym al cells and degraded by hepatic sinusoidal endothelial cells by a specific receptor-mediated process. Elevated levels are associated with the sinusoi dal capillarization that is seen in cirrhosis, Methodology Serum hyaluronan was measured, using a radiometric assay (Pharm acia, Sweden) in 221 patients with biopsy-proven chronic liver disease of a variety of aetiologies (alcohol n = 70, autoimmune chronic active hepatiti s n = 23, primary biliary cirrhosis n = 17, hepatitis C n = 69, cryptogenic n = 15, various n = 27), All patients were fasted, and their liver functio n tests, full blood count, prothrombin time and Child-Pugh score were asses sed at the time of the liver biopsy. Results Hyaluronan levels (mug/l) were significantly higher in patients wit h liver cirrhosis (cirrhosis n = 127, mean 440, 95% CI 367-515) (P < 0.0001 ) compared with hepatic fibrosis (n = 23, mean 144, 95% CI 69-190), chronic hepatitis (n = 60, mean 63, 95% CI 37-91) and fatty liver (n = 11, mean 10 7, 95% CI 37-177), Within the cirrhotic population, there was no significan t difference in hyaluronan levels between different aetiologies, but hyalur onan level increased proportionally to the severity of cirrhosis. Overall, a hyaluronan level > 100 mug/l had a 78% specificity and 83% sensitivity fo r diagnosing cirrhosis, while the specificity was increased to 96% for all patients with hyaluronan levels > 300 mug/l, The highest specificity and se nsitivity were seen at a cut-off value of 100 mug/l in patients with alcoho l-associated liver disease (89%, 87%) and hepatitis C (93%, 72%) respective ly. Within patient cohorts, there was a significant correlation (P<0.01) be tween hyaluronan and albumin, platelet count and bilirubin, but not with al anine aminotransferase. Conclusion Measurement of fasted serum hyaluronan reliably differentiated c irrhotic from non-cirrhotic liver disease and can be regarded as a useful t est in the diagnosis of liver cirrhosis, particularly when a liver biopsy i s contraindicated. (C) 2000 Lippincott Williams & Wilkins.