title: Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease.
abstract: OBJECTIVE
  Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease from simple steatosis to cirrhosis. Therefore, markers for predicting NAFLD with advanced fibrosis are needed. The aim of this study was to establish non-invasive predictive markers of liver fibrosis in NAFLD.
  
  
  METHODS
  One hundred and forty-eight patients were diagnosed as having biopsy-proven NAFLD. In order to separately identify severe fibrosis (bridging fibrosis plus cirrhosis) and cirrhosis, the patients were analyzed twice: first, as mild fibrosis versus severe fibrosis; and second, as non-cirrhosis versus cirrhosis. Univariate and multivariate analyses were conducted. The diagnostic ability to detect severe fibrosis and cirrhosis was assessed by the area under the receiver operating characteristic curve. The cut-off values of serum markers to detect severe fibrosis and cirrhosis were determined.
  
  
  RESULTS
  Hyaluronic acid was selected as a predictive marker for severe fibrosis. A cut-off value of 42 ng/mL of hyaluronic acid had a 100% predictive value for patients free of severe fibrosis and was associated with an optimal combination of sensitivity (100%, 95% confidence interval [CI] 90-100%) and specificity (89%, 95%CI 80-94%). The platelet count was found to be an independent predictor of cirrhosis. A cut-off value of 16 x 10(4)/microL for the platelet count was associated with an optimal combination of sensitivity (100%, 95%CI 82-100%) and specificity (95%, 95%CI 90-98%).
  
  
  CONCLUSIONS
  Hyaluronic acid levels can accurately identify NAFLD patients with severe fibrosis, and the platelet count can identify NAFLD patients with cirrhosis. Thus, these markers offer a good guideline for the assessment of hepatic fibrosis in the many patients with NAFLD.
authors.affiliation: Department of Internal Medicine and Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kaneda
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
authors.forename: Satoru
authors.initials: S
authors.lastname: Yatsuji
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Tokushige
authors.forename: Keiko
authors.initials: K
authors.lastname: Shiratori
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005234:Fatty Liver / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000097:blood / Q000175:diagnosis; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D007564:Japan; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D012189:Retrospective Studies
chemical_list: D006820:Hyaluronic Acid