Serum hyaluronic acid as a marker of hepatic fibrosis

ABSTRACT

To determine the serum hyaluronic acid [HA] levels as biochemical marker of hepatic fibrosis and cirrhosis and correlate it with the degree of hepatic fibrosis and cirrhosis. Comparative cross-sectional study. The Armed Forces Institute of Pathology, Rawalpindi from September 2003 to August 2004. This study was performed on 100 patients of chronic liver disease whose liver biopsies had been carried out. Fifty healthy controls were also included in the study. Routine liver function tests, hepatitis serology and serum hyaluronic acid levels were carried out on patients and controls. Liver biopsy of 100 patients revealed that 21 were in stage 0 fibrosis, 38 in stage 1 fibrosis, 26 in stage 3 fibrosis and 15 in stage 4 fibrosis. Mean Serum HA [mean +/- SD] concentration in patients were 189 +/- 98 micro g/L vs. 21 +/- 10 micro g/L of healthy controls. The difference observed was statistically significant [p < 0.001]. Patients in stage 4 fibrosis had significantly higher [p <0.001] mean serum HA concentration as compared to other stages of liver fibrosis. Diagnostic accuracy of serum HA at marginally elevated level of 60 micro g/L determined the sensitivity 78.4%, specificity 80.9%, positive predicted value 93.9% and negative predicted value of 50%. Serum HA is a useful non-invasive marker of liver fibrosis. There is a strong positive correlation between serum HA levels and degree of liver fibrosis. The concentration of serum HA rises according to progression of liver fibrosis and levels are highest in patients with liver cirrhosis