title: Measurement of serum hyaluronic acid in patients with chronic hepatitis C and its relationship to liver histology. Consensus Interferon Study Group.
abstract: OBJECTIVE
  Chronic hepatitis C is a slowly progressing inflammatory disease of the liver that can lead to cirrhosis and its complications. Assessment of liver damage in hepatitis C has been primarily via histological evaluation. 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 in small patient populations have identified serum markers shown to correlate with liver histology, including procollogen III peptide and hyaluronic acid (HA). To determine whether serum HA was a reliable predictor of cirrhosis and fibrosis, we examined serum HA concentrations from 486 chronic Hepatitis C virus (HCV) patients.
  
  
  RESULTS
  Patients were anti-HCV and HCV RNA positive, with elevated alanine aminotransferase values and underwent a liver biopsy. Sera were obtained at the baseline for HA using radioimmunoassay methodology. Patients with cirrhosis had significantly higher serum HA concentrations compared with non-cirrhotic patients (382+/-31 vs 110+/-9 microg/L respectively, P< 0.001). Patients with fibrosis had significantly higher mean serum HA concentrations (179+/-11 microg/L) compared with patients without fibrosis (62+/-20 microg/L; P< 0.001). The correlation between HA concentration and the components of the Knodell histological activity index score revealed no strong associations with the exception of fibrosis, which showed moderate correlation (R=0.5421, P<0.001). The clinical value of HA measurement appears to be its ability to exclude cirrhosis. A HA value of < 60 microg/L excluded the presence of cirrhosis or significant fibrosis with a predictive value of 99 and 93%, respectively.
  
  
  CONCLUSIONS
  Serum HA measurement may be clinically useful to non-invasively assess the degree of fibrosis and cirrhosis. Further prospective studies are warranted to determine the clinical utility of HA as a non-invasive marker of liver fibrosis.
authors.affiliation: Division of Gastroenterology/Hepatology, Scripps Clinic, La Jolla, California 92037, USA. jmchutchison@scrippsclinic.com
authors.forename: J G
authors.initials: JG
authors.lastname: McHutchison
authors.forename: L M
authors.initials: LM
authors.lastname: Blatt
authors.forename: M
authors.initials: M
authors.lastname: de Medina
authors.forename: J R
authors.initials: JR
authors.lastname: Craig
authors.forename: A
authors.initials: A
authors.lastname: Conrad
authors.forename: E R
authors.initials: ER
authors.lastname: Schiff
authors.forename: M J
authors.initials: MJ
authors.lastname: Tong
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D016013:Likelihood Functions; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011863:Radioimmunoassay; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid