Serum hyaluronic acid in chronic viral hepatitis B and C: a biomarker for assessing liver fibrosis in chronic hemodialysis patients

• Published in: International urology and nephrology 2015-07, Vol.47 (7), p.1209-1217
• Main Authors: Orăşan, Olga Hilda, Sava, Mădălina, Iancu, Mihaela, Cozma, Angela, Saplonţai-Pop, Aniela, Sarlea Ţărmure, Simina, Lungoci, Corneliu, Orăşan, Remus Aurel, Patiu, Ioan Mihai, Dumitraşcu, Dan Lucian
• Format: Article
• Language: English
• Subjects: Adult; Aged; Alanine Transaminase - blood; Aspartate Aminotransferases - blood; Biomarkers - blood; Diagnosis, Differential; Female; Hepatitis B virus; Hepatitis B, Chronic - blood; Hepatitis B, Chronic - complications; Hepatitis C, Chronic - blood; Hepatitis C, Chronic - complications; Humans; Hyaluronic Acid - blood; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Liver Cirrhosis - blood; Liver Cirrhosis - diagnosis; Liver Cirrhosis - etiology; Male; Medicine; Medicine & Public Health; Middle Aged; Nephrology; Nephrology - Original Paper; Patient Acuity; Renal Dialysis; Reproducibility of Results; Urology
• ISSN: 0301-1623; 1573-2584
• DOI: 10.1007/s11255-015-1017-x

Purpose 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).