Open Access Research article

Can serum hyaluronic acid replace simple non-invasive indexes to predict liver fibrosis in HIV/Hepatitis C coinfected patients?

Salvador Resino1*, José M Bellón2, Cristina Asensio3, Dariela Micheloud14, Pilar Miralles5, Ana Vargas1, Pilar Catalán6, Juan C López5, Emilio Álvarez7, Jaime Cosin5, Raquel Lorente8, María A Muñoz-Fernández68 and Juan Berenguer5

Author Affiliations

1 Laboratory of Molecular Epidemiology of Infectious Diseases, National Centre of Microbiology, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain

2 Biomedical Research Foundation, Hospital General Universitario "Gregorio Marañón", Madrid, Spain

3 Agency for Health Technology Assessment, Instituto de Salud Carlos III, Madrid, Spain

4 Internal Medicine Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain

5 Infectious Diseases-HIV Unit, Hospital General Universitario "Gregorio Marañón", Madrid, Spain

6 Microbiology Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain

7 Pathology Department, Hospital General Universitario "Gregorio Marañón", Madrid, Spain

8 Molecular Immunobiology Laboratory, Hospital General Universitario "Gregorio Marañón", Madrid, Spain

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BMC Infectious Diseases 2010, 10:244  doi:10.1186/1471-2334-10-244

Published: 19 August 2010

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.