Serum concentration of hyaluronic acid correlates with the ­degree of fibrosis and portal hypertension


Authors: R. Brůha 1;  T. Zima 2;  K. Pelinková 2;  P. Urbánek 3;  M. Leníček 2;  I. Subhanová 2;  K. Dvořák 1;  J. Petrtýl 1;  J. Stříteský 4;  H. Benáková 2;  L. Vítek 1,2
Authors‘ workplace: IV. interní klinika – klinika gastroenterologie a hepatologie, VFN a 1. LF UK v Praze 1;  Ústav klinické biochemie a laboratorní diagnostiky, 1. LF UK v Praze 2;  Interní klinika, ÚVN a 1. LF UK v Praze 3;  Ústav patologie, 1. LF UK v Praze 4
Published in: Gastroent Hepatol 2011; 65(3): 126-132
Category: Hepatology: Original Article

Overview

Liver biopsy is a gold standard in the evaluation of liver diseases. Beside the diagnosis of liver diseases, liver biopsy is usually used to assess inflammatory activity and the degree of fibrotisation. Recently, non-invasive parameters have been considered to substitute liver biopsy. The severity of fibrosis correlates with serum concentrations of some substances which are involved in the process of fibrotisation, like hyaluronic acid (HA), which is also part of the diagnostic Hepascore index. Serum concentration of HA was described as elevated in patients with chronic HCV infection; less information has been published regarding other liver diseases. The aim of our study was: to assess the diagnostic value of serum HA and Hepascore for the evaluation of fibrosis and portal hypertension in patients with liver disease of different aetiology. Serum concentrations of HA and Hepascore were measured in 86 patients (59 men; average age 49.6±14.7 years) with chronic liver disease, indicated for liver biopsy. The aetiology of liver disease was NASH in 15, ethylic in 31, HCV in 31 and other in 9 patients. In 35 patients, the hepatic venous pressure gradient was measured. For statistical evaluation, ANOVA and correlation analyses were used. The degree of fibrosis was described using the METAVIR classification. Fibrosis F0–F1 was detected in 19 patients, F2–F3 in 20 patients and F4 was described in 47 patients. Serum concentrations of HA were as follows (µg/l, median, IQ range): F0: 22.4 (13.3–47.3); F1: 20.1 (14.8–26.3); F2: 32.7 (27.1–45.2); F3: 59.9 (48.1–69.1); F4: 188.7 (139.6–449.7). A statistically significant difference in HA and Hepascore was found between F4 and all other fibrosis stages (p<0.05). Hepascore correlated significantly with the severity of portal hypertension in F4 patients. Serum concentrations of bilirubin, GGT, ALT did not correlate with the fibrosis. Significant differences in the serum concentration of HA and Hepascore values were found between patients with different degrees of liver fibrosis. Moreover, HA and Hepascore correlated clearly with the degree of portal hypertension. These parameters could describe the presence of severe fibrosis without the need for liver biopsy.

Key words:
cirrhosis – liver fibrosis – Hepascore – hyaluronic acid – non-invasive parameters of fibrosis – portal hypertension


Sources

1. Ehrmann J, Hůlek P et al. Hepatologie. Praha: Grada Publishing 2010. 616 stran.

2. Gilmore IT, Burroughs A, Murray-Lyon IM et al. Indications, methods, and outcomes of percutaneous liver biopsy in England and Wales: an audit by the British Society of Gastroenterology and the Royal College of Physicians of London. Gut 1995; 36(3): 437–441.

3. Regev A, Berho M, Jeffers LJ et al. Sampling error and intraobserver variation in liver biopsy in patients with chronic HCV infection. Am J Gastroenterol 2002; 97(10): 2614–2618.

4. Sebastiani G. Non-invasive assessment of liver fibrosis in chronic liver diseases: Implementation in clinical practice and decisional algorithms. World J Gastroenterol 2009; 15(18): 2190–2203.

5. Rosenberg WMC, Voelker M, Thiel R et al. Serum markers detect the presence of liver fibrosis: A cohort study. Gastro­enterol 2004; 127(6): 1704–1713.

6. Wieckowska A, McCullough AJ, Feldstein AE. Noninvasive diagnosis and monitoring of nonalcoholic steatohepatitis: present and future. Hepatology 2007; 46(2): 582–589.

7. Murawaki Y, Ikuta Y, Okamoto K et al. Dia­gnostic value of serum markers of connective tissue turnover for predicting histological staging and grading in patients with chronic hepatitis C. J Gastroenterol 2001; 36(6): 399–406.

8. Halfon P, Bourliere M, Penaranda G et al. Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus. Comp Hepatol 2005; 4: 6.

9. Naveau S, Raynard B, Ratziu V et al. Bio­markers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease. Clin Gastroenterol Hepatol 2005; 3(2): 167–174.

10. McHutchison JG, Blatt LM, de Medina M et al. Measurement of serum hyaluronic acid in patients with chronic hepatitis C and its relationship to liver histology. Consensus Interferon Study Group. J Gastroenterol Hepatol 2000; 15(8): 945–951.

11. Imbert-Bismut F, Ratziu V, Pieroni L et al. Biochemical markers of liver fibrosis in patients with hepatitis C virus infection: a prospective study. Lancet 2001; 357(9262): 1069–1075.

12. Ratziu V, Massard J, Charlotte F et al. Diagnostic value of biochemical markers (FibroTest-FibroSURE) for the prediction of liver fibrosis in patients with non-alcoholic fatty liver disease. BMC Gastroenterol 2006; 6: 6.

13. Adams LA, Bulsara M, Rossi E et al. Hepascore: an accurate validated predictor of liver fibrosis in chronic hepatitis C infection. Clin Chem 2005; 51(10): 1867–1873.

14. Guha IN, Parkes J, Roderick P et al. Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European liver fibrosis panel and exploring simple markers. Hepatology 2008; 47(2): 455–460.

15. Zhang YX, Wu WJ, Zhang YZ et al. Noninvasive assessment of liver fibrosis with combined serum aminotransferase/platelet ratio index and hyaluronic acid in patients with chronic hepatitis B. World J Gastro­enterol 2008; 14(46): 7117–7121.

16. Brůha R, Petrtýl J. Význam měření HVPG u pacientů s cirhózou. Gastroent ­Hepatol 2011; 65(3): 143–148.

17. Guechot J, Lasnier E, Sturm N et al. Automation of the Hepascore and validation as a biochemical index of liver fibrosis in patients with chronic hepatitis C from the ANRS HC EP 23 Fibrostar cohort. Clinica Chimica acta 2010; 411(1–2): 86–91.

18. Suzuki A, Angulo P, Lymp J et al. Hyaluronic acid, an accurate serum marker for severe hepatic fibrosis in patients with non-alcoholic fatty liver disease. Liver Int 2005; 25(4): 779–786.

19. Sandrin L, Fourquet B, Hasquenoph JM et al. Transient elastography: a new noninvasive method for assessment of hepatic fibrosis. Ultrasound Med Biol 2003; 29(12): 1705–1713.

20. Rockey DC, Caldwell SH, Goodman ZD et al. Liver Biopsy. Hepatology 2009; 49(3): 1017–1044.

21. Thalheimer GL, Mela M, Patch D et al. Systematic review of HVPG measurement: statistics versus clinical applicability. Gastro­enterology 2007; 132(3): 1201–1202.

22. Kalambokis G, Manousou P, Vibhakorn S et al. Transjugular liver biopsy–indica­tions, adequacy, quality of specimens, and complications–a systematic review. J He­patol 2007; 47(2): 284–294.

23. Bedossa P, Poynard T. An algorithm for the grading of activity in chronic hepatitis C. The METAVIR Cooperative Study Group. Hepatology 1996; 24(2): 289–293.

24. Naveau S, Gaude G, Asnacios A et al. Dia­gnostic and prognostic values of noninvasive biomarkers of fibrosis in patients with alcoholic liver disease. Hepatology 2009; 49(1): 97–105.

25. Naveau S, Raynard B, Ratziu V et al. Bio­markers for the prediction of liver fibrosis in patients with chronic alcoholic liver disease. Clin Gastroenterol Hepatol 2005; 3(2): 167–174.

26. Alberti A, Clumeck N, Collins S et al. Short statement of the first European Consensus Conference on the treatment of chronic hepatitis B and C in HIV co-infected patients. J Hepatol 2005; 42(5): 615–624.

27. Sebastiani G, Halfon P, Castera L et al. SAFE biopsy: a validated method for ­large-scale ­staging of liver fibrosis in chronic hepatitis C. Hepatology 2009; 49(6): 1821–1827.

28. Brunt EM, Tiniakos DG. Pathological features of NASH. Front Biosci 2005; 10: 1475–1484.

Labels
Paediatric gastroenterology Gastroenterology and hepatology Surgery

Article was published in

Gastroenterology and Hepatology

Issue 3

2011 Issue 3

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account