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

OBJECTIVE 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. CONCLUSION 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.