Serum hyaluronate as a non-invasive marker of hepatic fibrosis and inflammation in HBeAg-negative chronic hepatitis B

Abstract

Background: HBV infection is a serious global heath problem. It is crucial to monitor this disease more closely with a non-invasive marker in clinical trials. We aimed to evaluate the predictive value of serum hyaluronate for the presence of extensive liver fibrosis and inflammation.

Methods: 28 healthy volunteers and 65 patients with HBeAg negative chronic hepatitis B were enrolled. Liver biopsies scored according to Ishak system. Association of serum hyaloronate with liver fibrosis and inflammation were assessed, and cut off points for serum hyaluronate levels were identified by receiver operating characteristics (ROC) curves and their values for prediction of fibrosis and inflammation were assessed.

Results: In patients with CHB serum hyaluronate had the most significant correlation and predictive values for the liver fibrosis and inflammation comparing to the other variables. At the cut off point of 126.4 ngm/ml it could discriminate extensive fibrosis from milder ones with sensitivity of 90.9% and specificity of 98.1%. With the same value it could discriminate extensive inflammation from their milder counterparts with sensitivity of 63.6% and specificity of 92.6%.

Conclusion: Serum hyaluronate was the best predictor of extensive liver fibrosis and inflammation and it could discriminate subgroups of patients with chronic hepatitis B. It could be used as a non-invasive test to monitor these patients more closely with developing anti viral agents in clinical trials.

Figure 1

Box plot of serum hyaluronate level in relation to the Ishak fibrosis score. The box represents the interquartile range, the whiskers indicate the highest and lowest values, and the circles represent outliers. The line across the box indicates the median value.

Figure 2

Receiver operating characteristics curve (ROC) of serum hyaluronate for discrimination of mild (stage 0–2) from significant (stage 3 or more) of fibrosis. Hyaluronate at cut off point of 126.43 ngm/ml could differentiate mild from severe fibrosis in patients with chronic hepatitis B.

Figure 3

Receiver operating characteristics curve (ROC) of hyaluronate for discrimination of mild (grade 0–8) from significant (grade ≥ 9) inflammation. Hyaluronate at cut off point of 126.43 ngm/ml could differentiate mild from severe inflammation in patients with chronic hepatitis B.