Serum hyaluronic acid level does not reliably differentiate minimal and significant liver disease in chronic hepatitis C

Objectives: 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.