Serum laminin and hyaluronan in liver cirrhosis: markers of progression with high prognostic value.
OBJECTIVE
In a prospective study with a mean follow-up period of 12.5 +/- 3.5 months, we investigated the extracellular matrix components laminin and hyaluronan in serum for their diagnostic value in portal hypertension and in clinically severe complications of progressive liver cirrhosis.


METHODS
In 38 patients with liver fibrosis (n = 4) and cirrhosis (Child A: n = 17, B: n = 7, C: n = 10), the serum concentrations of laminin and hyaluronan were determined. Portal hypertension was assessed by endoscopic control of the esophageal varices and by Doppler sonography of the portal blood flow.


RESULTS
Neither laminin nor hyaluronan correlated with portal hypertension, but highly significantly increased (p < 0.001) concentrations of 3.25 +/- 0.2 U/ml (laminin) and 493 +/- 248 ng/ml (hyaluronan) were found in patients with complications of liver cirrhosis when compared to those without complications (Ln: 2.13 +/- 0.26 U/ml, HA: 206 +/- 184 ng/ml). At cut-off levels of 2.6 U/ml (laminin) and 200 ng/ ml (hyaluronan), the diagnostic sensitivity and specificity for severe complications of liver cirrhosis was 0.71 and 0.86 (Ln) and 0.90 and 0.67 (HA), respectively. The positive predictive values were of 0.8 (laminin) and 0.6 (hyaluronan). The relative risk of patients presenting elevated concentrations of laminin or hyaluronan at the start of the study for later development of severe complications was 2.7.


CONCLUSIONS
Both parameters, especially serum laminin, can be used as prognostic markers in addition to the Child criteria in liver cirrhosis.
Körner
T
T
Department of Internal Medicine II, Klinikum Suhl, Germany.
Kropf
J
J
Gressner
A M
AM
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D018450:Disease Progression; D004932:Esophageal and Gastric Varices / Q000150:complications*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D006975:Hypertension, Portal / Q000150:complications*; D007797:Laminin / Q000097:blood*; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D018570:Risk Assessment
D015415:Biomarkers; D007797:Laminin; D006820:Hyaluronic Acid