title: Predictive accuracy of serum hyaluronic acid as a non-invasive marker of fibrosis in a cohort of multi-transfused Egyptian children with β-thalassaemia major.
abstract: OBJECTIVE
  Liver disease remains a major cause of morbidity and mortality in patients with β-thalassaemia major (β-TM); therefore, its identification at an early stage is of great significance. Serum hyaluronic acid (HA) is considered as a non-invasive marker that appears early before pathological changes occur. We aim to determine the predictive accuracy of HA in detecting and staging hepatic fibrosis in β-TM patients.
  
  
  METHODS
  30 Egyptian children with β-TM, and 15 age and sex-matched controls were studied. All had abdominal ultrasonography (US), measurement of serum amino-transferases (ALT, AST); hepatitis C, B and human immunodeficiency viruses (HCV, HBV, HIV) sero-markers, serum ferritin and HA. Liver biopsy was done for patients and fibrosis was scaled using Metavir scoring system and liver iron concentration (LIC) was measured.
  
  
  RESULTS
  Twenty patients (67.7%) had sero-markers of HCV, none had HBV or HIV. Serum HA was significantly higher in patients (90.78±28.79 ng/ml) compared to controls (21.1±13.24 ng/ml) with p<0.05. No difference between HCV infected and non-infected patients was detected. Positive significant correlation was detected between serum HA and stages of fibrosis by histopathology and US. No correlation was found between serum HA and age, sex, weight, height, haemoglobin level, platelet count, AST, serum ferritin, necro-inflammatory grade, and LIC.
  
  
  CONCLUSIONS
  Serum HA is a valuable non-invasive marker that may contribute to the assessment of liver fibrosis in multi-transfused children and adolescents with β-TM, irrespective of concomitant HCV infection.
authors.affiliation: Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt.
authors.forename: Mortada H F
authors.initials: MH
authors.lastname: El-Shabrawi
authors.forename: Maha Y
authors.initials: MY
authors.lastname: Zein El Abedin
authors.forename: Naglaa
authors.initials: N
authors.lastname: Omar
authors.forename: Naglaa M
authors.initials: NM
authors.lastname: Kamal
authors.forename: Sayed Abou
authors.initials: SA
authors.lastname: Elmakarem
authors.forename: Sahar
authors.initials: S
authors.lastname: Khattab
authors.forename: Hussein M
authors.initials: HM
authors.lastname: El-Sayed
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Hennawy
authors.forename: Ali S M
authors.initials: AS
authors.lastname: Ali
mesh_terms: D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D016022:Case-Control Studies; D002648:Child; D004534:Egypt; D005260:Female; D016174:Hepacivirus / Q000276:immunology; D006526:Hepatitis C / Q000150:complications / Q000276:immunology; D018937:Hepatitis C Antibodies / Q000097:blood; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D010865:Pilot Projects; D011237:Predictive Value of Tests; D012372:ROC Curve; D018709:Statistics, Nonparametric; D014463:Ultrasonography; D017086:beta-Thalassemia / Q000150:complications*
chemical_list: D015415:Biomarkers; D018937:Hepatitis C Antibodies; D006820:Hyaluronic Acid