Replacement of hystological findings: serum hyaluronic acid for fibrosis, high-sensitive C-reactive protein for necroinflamation in chronic viral hepatitis

Abstract

Because of limitations in biopsy procedure, several non-invasive tests have been developed for predicting the histological findings in chronic hepatitis. A fibrosis (F) score 1 or above and necroinflammation [histological activity index (HAI)] score 4 or above are required to initiate the treatment in chronic viral hepatitis. Literature includes many studies on hyaluronic acid (HA) as a non-invasive procedure in predicting histological findings but lacks on high-sensitive-C-reactive protein (hsCRP). We evaluated the diagnostic value of HA and hsCRP in patients with chronic viral hepatitis. Ninety-eight subjects (42 chronic viral hepatitis, 28 cirrhosis and 28 healthy controls) were included in the study. Liver biopsies were performed on 42 chronic hepatitis patients and assessed by Ishak scoring system. All sera were stored at -70 degrees C until assay. Many laboratory parameters related to viral hepatitis, HA and hsCRP were studied following the instructions. We tried to determine a cut-off value for HA to represent > or =F1 score and that for hsCRP to represent > or =4 HAI score. Hepatitis B virus was the predominant aetiology of chronic hepatitis in our study. Mean HA levels were 113, 754 and 24 ng/ml in patients with chronic hepatitis, cirrhosis and controls, respectively (anova, p < 0.001). A HA level >64.7 ng/ml had a 100% specificity for diagnosing chronic hepatitis. A value > or =154 ng/ml had a 100% specificity, 100% positive predictive value and 90% negative predictive value for diagnosing liver cirrhosis (Area 1.00; p < 0.0001). A cut-off value of 63 ng/ml for HA had a 100% specificity for diagnosing fibrosis score > or =1 in chronic hepatitis (Area 0.86; p < 0.001). An hsCRP level >0.56 mg/dl had a 100% specificity and 12% sensitivity for diagnosing chronic hepatitis (Area 0.71; p = 0.002), while cut-off of 0.53 mg/dl had 75% specificity for diagnosing HAI > or = 4 in chronic hepatitis (Area 0.32; p = 0.132). This study supported the HA level in predicting fibrosis score > or =1 with a cut-off value of 63 ng/ml. Cut-off of 154 ng/ml had a strong worth for cirrhosis. A cut-off of hsCRP for predicting HAI score > or =4 warrants further evaluation in wider study populations. We concluded that we are a bit closer to the strategy for guiding therapy in patients with chronic hepatitis, without a liver biopsy.

Effect of vitamin D therapy on interleukin-6, visfatin, and hyaluronic acid levels in chronic hepatitis C Egyptian patients

“…It has been suggested that serum IL-6,20 visfatin,9,21 and HA10,11,22 values were elevated in HCV. As shown in Table 1, both groups had elevated baseline serum IL-6 and HA, although they were significantly lower in the patient group compared to the control group (control 327.6 vs study 304 ng/mL; P =0.001) and (control 239.9 vs study 223.2 ng/mL; P =0.001), respectively.…”

“…Liver biopsy, while useful in determining the extent of liver damage, has associated costs and places patients at a small but finite risk of bleeding. Studies have identified serum markers shown to correlate with liver histology, including procollagen III peptide and hyaluronic acid (HA) 10. Serum HA measurement is clinically useful to noninvasively assess the degree of fibrosis and cirrhosis.…”

Comparison of non-invasive assessment to diagnose liver fibrosis in chronic hepatitis B and C patients

“…The HA levels in serum are increased in advanced liver diseases, which is caused by increasing amounts of fibroblasts and hepatic stellate cells [12,13].…”

Diagnostic Value of the Quantitative Titer of High-Sensitivity C-Reactive Protein in the Detection of Clinical Stages of Chronic Hepatitis B Infection

“…Also, in a study carried out by Yilmaz et al the serum level of hs-CRP differed between hepatitis and control groups, although this difference was not statistically significant. In this study, hs-CRP level of > 0.56 mg/dL showed 100% specificity and 12% sensitivity in the diagnosis of chronic hepatitis (area: 0.71; P = 0.002) (9). Also, according to a comparative study by Shima et al CRP expression was correlated with the progression of HBV infection (12).…”

“…Creactive protein (CRP) is a member of the class of acutephase reactants, released by hepatocytes in response to acute injury, infection, or other inflammatory stimuli. CRP expression in hepatocytes is regulated by cytokines, such as interleukin-1 (IL-1), interlukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) (9). This enhancement is due to the rise in the plasma concentration of IL-6, which is predominantly produced by macrophages.…”