title: Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus.
abstract: BACKGROUND
  In patients with chronic hepatitis C virus, liver biopsy is the gold standard for assessing liver disease stage; nevertheless, it is prone to complications, some of them serious. Non-invasive methods have been proposed as surrogate markers for liver fibrosis. It was shown that serum hyaluronic acid (HA) level increases with the development for liver fibrosis. The aim of this study was to evaluate the diagnostic value of HA as well as to determine the HA level cut-off for predicting the presence or absence of fibrosis, severe fibrosis, and cirrhosis.
  
  
  RESULTS
  405 patients with chronic hepatitis C were prospectively included with biomarker measurement and liver biopsy done the same day: 151 in the training set (only biopsy lengths of 25 mm or more) and 254 in the validation set. For the discrimination of significant fibrosis, severe fibrosis, and cirrhosis in the training set, the areas under curve (AUCs) were 0.75 +/- 0.03, 0.82 +/- 0.02, and 0.89 +/- 0.03, respectively. Absence of significant fibrosis, severe fibrosis, and cirrhosis can be predicted by HA levels of 16, 25, and 50 microg/l, respectively (with negative predictive values of 82%, 89%, and 100%, in the same order). Presence of significant fibrosis, severe fibrosis, and cirrhosis can be predicted by HA levels of 121, 160, and 237 microg/l, respectively (with positive predictive values of 94%, 100%, and 57%, in the same order).
  
  
  CONCLUSIONS
  In the validation set, HA was accurate in predicting significant fibrosis, severe fibrosis, and cirrhosis with AUCs of 0.73, 0.77, and 0.97, respectively. Moreover, accurate HA level cut-offs were defined for predicting significant fibrosis, severe fibrosis, and cirrhosis. Thus, the study supports that HA level may be clinically useful as a non-invasive marker for liver fibrosis and/or cirrhosis.
authors: Department of Virology, Alphabio Laboratory, Marseille, France. philippe.halfon@alphabio.fr
authors: Philippe
authors: P
authors: Halfon
authors: Marc
authors: M
authors: Bourlière
authors: Guillaume
authors: G
authors: Pénaranda
authors: Romaric
authors: R
authors: Deydier
authors: Christophe
authors: C
authors: Renou
authors: Danielle
authors: D
authors: Botta-Fridlund
authors: Albert
authors: A
authors: Tran
authors: Isabelle
authors: I
authors: Portal
authors: Isabelle
authors: I
authors: Allemand
authors: Alessandra
authors: A
authors: Rosenthal-Allieri
authors: Denis
authors: D
authors: Ouzan