Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

Abstract

BackgroundHyaluronic acid (HA) serum levels correlate with the histological stages of liver fibrosis in hepatitis C virus (HCV) monoinfected patients, and HA alone has shown very good diagnostic accuracy as a non-invasive assessment of fibrosis and cirrhosis. The aim of this study was to evaluate serum HA levels as a simple non-invasive diagnostic test to predict hepatic fibrosis in HIV/HCV-coinfected patients and to compare its diagnostic performance with other previously published simple non-invasive indexes consisting of routine parameters (HGM-1, HGM-2, Forns, APRI, and FIB-4).MethodsWe carried out a cross-sectional study on 201 patients who all underwent liver biopsies and had not previously received interferon therapy. Liver fibrosis was determined via METAVIR score. The diagnostic accuracy of HA was assessed by area under the receiver operating characteristic curves (AUROCs).ResultsThe distribution of liver fibrosis in our cohort was 58.2% with significant fibrosis (F≥2), 31.8% with advanced fibrosis (F≥3), and 11.4% with cirrhosis (F4). Values for the AUROC of HA levels corresponding to significant fibrosis (F≥2), advanced fibrosis (F≥3) and cirrhosis (F4) were 0.676, 0.772, and 0.863, respectively. The AUROC values for HA were similar to those for HGM-1, HGM-2, FIB-4, APRI, and Forns indexes. The best diagnostic accuracy of HA was found for the diagnosis of cirrhosis (F4): the value of HA at the low cut-off (1182 ng/mL) excluded cirrhosis (F4) with a negative predictive value of 99% and at the high cut-off (2400 ng/mL) confirmed cirrhosis (F4) with a positive predictive value of 55%. By utilizing these low and high cut-off points for cirrhosis, biopsies could have theoretically been avoided in 52.2% (111/201) of the patients.ConclusionsThe diagnostic accuracy of serum HA levels increases gradually with the hepatic fibrosis stage. However, HA is better than other simple non-invasive indexes using parameters easily available in routine clinical practice only for the diagnosing of cirrhosis.

Role of hyaluronic acid and laminin as serum markers for predicting significant fibrosis in patients with chronic hepatitis B

“…5 For many years, liver biopsy has been considered the gold standard for staging and grading hepatic fibrosis and inflammation. 1,6 However, the procedure is associated with complications such as bleeding, infection, damage to liver tissue, etc, 6,7 and it is difficult to put into practice. Currently, with the improvements in treatment modalities for chronic liver disease, there is an increasing need for rapid, safe and reliable noninvasive diagnostic methods to stage liver fibrosis, and some of which have been widely validated in patients with chronic hepatitis.…”

“…Currently, with the improvements in treatment modalities for chronic liver disease, there is an increasing need for rapid, safe and reliable noninvasive diagnostic methods to stage liver fibrosis, and some of which have been widely validated in patients with chronic hepatitis. [7][8][9][10][11][12][13][14][15] The ECM components in the liver include non-collagenous glycoproteins such as hyaluronic acid (HA), laminin (LN) and proteoglycans, etc. In the liver, HA is a glycosaminoglycan, which is mostly synthesized by hepatic stellate cells and degraded by sinusoidal endothelial cells.…”

Hyaluronic acid as a non-invasive biomarker of liver fibrosis

“…Nunes et al (61) present a cohort of HCV patients co-infected with human immunodeficiency virus (HIV). Patients with HIV/viral hepatitis co-infection are also described in a number of other studies (62)(63)(64). Moreover, plasma HA also has the ability to predict the risk of liver-related events (hepatic coma or liver-related death), as investigated in the EuroSIDA study (64).…”

Impact of Low Versus Conventional Doses of Chemotherapy During Transcatheter Arterial Chemo-embolization on Serum Fibrosis Indicators and Survival of Liver Cancer Patients

“…Liver fibrosis implys the ultra-precipitation of hepatic extracellular matrix especially collagen, which is a repair response of injury in liver parenchyma. Now some indicators were considered to have diagnostic significance in detecting liver cirrhosis, including HA, LN, PCⅢ and C-Ⅳ (Collazos et al, 1993;Resino et al, 2010). As HCC mostly occurred during hepatic cirrhosis in China, the extent of hepatic cirrhosis in a clinical setting will greatly influence curative effect, complication and prognosis of treatment for HCC patients.…”