title: Serum hyaluronic acid level does not reliably differentiate minimal and significant liver disease in chronic hepatitis C.
abstract: OBJECTIVE
  To evaluate the predictive value of hyaluronic acid (HA) for the assessment of liver fibrosis and inflammation in chronic hepatitis C (CHC).
  
  
  METHODS
  This cross-sectional study was conducted at Ziauddin University, Karachi, Pakistan from June 2006 to July 2010. Ninety-eight CHC patients, 52 (53%) males, and 46 (47%) females, with an age range of 20-60 years (mean 36.0+/-10.5) were recruited. Liver fibrosis was staged on a 5-point scale, F0 to F4, and inflammation was graded on a 4-point scale, A0 to A3. Patients were divided into minimal (F<2 and A<2) and significant (F>/=2 or A>/=2) overall disease groups. The HA was measured in the serum by ELISA. Diagnostic value was assessed through receiver operating characteristic (ROC) curve.
  
  
  RESULTS
  Significant liver disease was present in 46 (47%) patients. Mean serum HA was significantly different among severity groups (p = 0.001). Area under ROC curve for overall disease was 0.716. Negative predictive value (NPV) for significant overall disease remained 71% at a low HA level of 20 ng/mL. Positive predictive value (PPV) of 85% was obtained at 60 ng/mL and 100% at 120 ng/mL. Those high levels were present in 15% and 10% of the patients.
  
  
  CONCLUSIONS
  Serum HA levels showed a low NPV for significant liver disease. An acceptable PPV was found only in a small proportion of the patients. Hyaluronic acid may not be regarded as a reliable marker for making treatment decisions.
authors.affiliation: Department of Pathology, College of Medicine, Alfaisal University, PO Box 50927, Riyadh 11533, Kingdom of Saudi Arabia. sa_arain@hotmail.com
authors.forename: Shoukat A
authors.initials: SA
authors.lastname: Arain
authors.forename: Sultan A
authors.initials: SA
authors.lastname: Meo
authors.forename: Qamar
authors.initials: Q
authors.lastname: Jamal
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D019698:Hepatitis C, Chronic / Q000473:pathology*; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index
chemical_list: D006820:Hyaluronic Acid