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

Abstract

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 (u.g/1, median, IQ range): F0: 22.4 (13.3-47.3); Fl: 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 degreesof liverfibrosis. 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.