title: Serum hyaluronic acid in chronic viral hepatitis B and C: a biomarker for assessing liver fibrosis in chronic hemodialysis patients.
abstract: OBJECTIVE
  Serum hyaluronic acid (sHA) is studied as a noninvasive marker of liver fibrosis (F) in chronic B and C viral hepatitis in general population but less in end-stage renal disease patients undergoing hemodialysis.
  
  
  METHODS
  We evaluated sHA as a noninvasive biomarker of F in a multicenter prospective, transversal, and observational study which included 52 end-stage renal disease patients with chronic B (14) and C (38) viral hepatitis (age 55.57 ± 14.46 years, dialysis vintage 132.59 ± 86.02 months).
  
  
  RESULTS
  Of the noninvasive tests analyzed, only sHA, APRI, and FIB4 index were able to differentiate patients with F1 (sHA p = 0.006; APRI p = 0.031; FIB4 p = 0.016). No statistically significant differences were found between sHA and APRI, ASAT/ALAT ratio, and FIB4 index in detecting F1 a (p > 0.02). sHA seemed to be more efficient than APRI, ASAT/ALAT ratio, and FIB4 index, having the highest estimated AUC value. The sHA threshold value for F1 was equal to 33.46 ng/mL, with the following estimated values of the performance indicators: Se 88.46 % and Sp 50 %. sHA was the only noninvasive test of the studied tests that could determine F2 (p = 0.002), with a threshold value of 80.24 ng/mL (Se 63 %, Sp 88 %), and F3 (p = 0.008), with a threshold value of 88.54 ng/mL (Se 60 %, Sp 84 %). None of the studied noninvasive tests could determine F4.
  
  
  CONCLUSIONS
  In patients with chronic B and C viral hepatitis undergoing hemodialysis, sHA may be a useful biomarker for the liver fibrosis grades: F1-mild, F2-moderate, and F3-severe, but it does not differentiate between chronic hepatitis (F1-F3) and liver cirrhosis (F4).
authors.affiliation: 4th Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania, olgaorasan@yahoo.com.
authors.forename: Olga Hilda
authors.initials: OH
authors.lastname: Orăşan
authors.forename: Mădălina
authors.initials: M
authors.lastname: Sava
authors.forename: Mihaela
authors.initials: M
authors.lastname: Iancu
authors.forename: Angela
authors.initials: A
authors.lastname: Cozma
authors.forename: Aniela
authors.initials: A
authors.lastname: Saplonţai-Pop
authors.forename: Simina
authors.initials: S
authors.lastname: Sarlea Ţărmure
authors.forename: Corneliu
authors.initials: C
authors.lastname: Lungoci
authors.forename: Remus Aurel
authors.initials: RA
authors.lastname: Orăşan
authors.forename: Ioan Mihai
authors.initials: IM
authors.lastname: Patiu
authors.forename: Dan Lucian
authors.initials: DL
authors.lastname: Dumitraşcu
mesh_terms: D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood*; D001219:Aspartate Aminotransferases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D003937:Diagnosis, Differential; D005260:Female; D019694:Hepatitis B, Chronic / Q000097:blood / Q000150:complications; D019698:Hepatitis C, Chronic / Q000097:blood / Q000150:complications; D006801:Humans; D006820:Hyaluronic Acid / Q000097:blood*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000209:etiology; D008297:Male; D008875:Middle Aged; D062072:Patient Acuity; D006435:Renal Dialysis; D015203:Reproducibility of Results
chemical_list: D015415:Biomarkers; D006820:Hyaluronic Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase