title: Noninvasive serum markers in the diagnosis of structural liver damage in chronic hepatitis C virus infection.
abstract: OBJECTIVE
  Several noninvasive markers are being used to assess the structural liver damage in patients with chronic hepatitis C (CHC). We evaluated the capacity of serum hyaluronic acid (HA), aspartate aminotransferase (AST)/ALT ratio, the AST to platelet ratio index (APRI) and gamma-glutamyltransferase (GGT) levels to predict the intensity of hepatic fibrosis in patients with CHC.
  
  
  METHODS
  In a total of 206 hepatitis C virus RNA-positive biopsied patients, AST, ALT, GGT levels, platelet count and serum HA concentration were determined. The APRI was calculated as the ratio of AST to platelets.
  
  
  RESULTS
  HA levels were best correlated with disease stage (r=-0.694; P<0.001). In the diagnosis of significant fibrosis (F2-F4), HA levels [AUC=0.879, 95% CI (0.832-0.927)] and APRI [AUC=0.824 (0.772-0.903)] were the markers with the best diagnostic accuracy. These parameters also best identified the presence of cirrhosis (F4), with an AUC of 0.908 (0.868-0.949) for HA and of 0.837 (0.772-0.903) for APRI.
  
  
  CONCLUSIONS
  Serum HA was the parameter that alone presented the best diagnostic accuracy in the assessment of hepatic fibrosis in CHC. The APRI showed a better diagnostic sensitivity than GGT levels or the AST/ALT ratio. Its simple determination and low cost make this index a valid alternative for the noninvasive staging of CHC.
authors.affiliation: Department of Gastroenterology, Federal University of São Paulo, São Paulo, Brazil. parise@gastro.epm.br
authors.forename: Edison R
authors.initials: ER
authors.lastname: Parise
authors.forename: Ana C
authors.initials: AC
authors.lastname: Oliveira
authors.forename: Cláudio
authors.initials: C
authors.lastname: Figueiredo-Mendes
authors.forename: Valéria
authors.initials: V
authors.lastname: Lanzoni
authors.forename: João
authors.initials: J
authors.lastname: Martins
authors.forename: Helena
authors.initials: H
authors.lastname: Nader
authors.forename: Maria L
authors.initials: ML
authors.lastname: Ferraz
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D019540:Area Under Curve; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D005260:Female; D019698:Hepatitis C, Chronic / Q000097:blood* / Q000150:complications*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000821:virology*; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011237:Predictive Value of Tests; D011446:Prospective Studies; D005723:gamma-Glutamyltransferase / Q000097:blood
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase