title: Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?
abstract: BACKGROUND
  Hyaluronic acid (HA) serum levels correlate with the histological stages of liver fibrosis in hepatitis C virus (HCV) monoinfected patients, and HA alone has shown very good diagnostic accuracy as a non-invasive assessment of fibrosis and cirrhosis. The aim of this study was to evaluate serum HA levels as a simple non-invasive diagnostic test to predict hepatic fibrosis in HIV/HCV-coinfected patients and to compare its diagnostic performance with other previously published simple non-invasive indexes consisting of routine parameters (HGM-1, HGM-2, Forns, APRI, and FIB-4).
  
  
  METHODS
  We carried out a cross-sectional study on 201 patients who all underwent liver biopsies and had not previously received interferon therapy. Liver fibrosis was determined via METAVIR score. The diagnostic accuracy of HA was assessed by area under the receiver operating characteristic curves (AUROCs).
  
  
  RESULTS
  The distribution of liver fibrosis in our cohort was 58.2% with significant fibrosis (F≥2), 31.8% with advanced fibrosis (F≥3), and 11.4% with cirrhosis (F4). Values for the AUROC of HA levels corresponding to significant fibrosis (F≥2), advanced fibrosis (F≥3) and cirrhosis (F4) were 0.676, 0.772, and 0.863, respectively. The AUROC values for HA were similar to those for HGM-1, HGM-2, FIB-4, APRI, and Forns indexes. The best diagnostic accuracy of HA was found for the diagnosis of cirrhosis (F4): the value of HA at the low cut-off (1182 ng/mL) excluded cirrhosis (F4) with a negative predictive value of 99% and at the high cut-off (2400 ng/mL) confirmed cirrhosis (F4) with a positive predictive value of 55%. By utilizing these low and high cut-off points for cirrhosis, biopsies could have theoretically been avoided in 52.2% (111/201) of the patients.
  
  
  CONCLUSIONS
  The diagnostic accuracy of serum HA levels increases gradually with the hepatic fibrosis stage. However, HA is better than other simple non-invasive indexes using parameters easily available in routine clinical practice only for the diagnosing of cirrhosis.
authors: Laboratory of Molecular Epidemiology of Infectious Diseases, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain. sresino@isciii.es
authors: Salvador
authors: S
authors: Resino
authors: José M
authors: JM
authors: Bellón
authors: Cristina
authors: C
authors: Asensio
authors: Dariela
authors: D
authors: Micheloud
authors: Pilar
authors: P
authors: Miralles
authors: Ana
authors: A
authors: Vargas
authors: Pilar
authors: P
authors: Catalán
authors: Juan C
authors: JC
authors: López
authors: Emilio
authors: E
authors: Alvarez
authors: Jaime
authors: J
authors: Cosin
authors: Raquel
authors: R
authors: Lorente
authors: María A
authors: MA
authors: Muñoz-Fernández
authors: Juan
authors: J
authors: Berenguer
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008099:Liver / Q000473:pathology; D008103:Liver Cirrhosis / Q000175:diagnosis* / Q000473:pathology*; D008297:Male; D011237:Predictive Value of Tests; D044967:Serum / Q000737:chemistry; D012720:Severity of Illness Index
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid