Determination of serum fibrosis index in patients with chronic hepatitis and its relationship to histological activity index

OBJECTIVE: To study the reliability of serum hyaluronic acid (HA) as a non-invasive method for the diagnosis of liver fibrosis and its relationship to liver biopsy findings.

METHODS: In a prospective controlled clinical trial, 48 patients with chronic liver disease were selected from Pediatric Departments, Al-Jedaany and Al-Hayat Hospitals, Jeddah, Kingdom of Saudi Arabia, from November 2005 to March 2008. Twenty-one with chronic hepatitis B infection, 17 with chronic hepatitis C infection, and 10 with autoimmune hepatitis in addition to 25 healthy controls. Serum HA and liver function tests were carried out for the studied cases. The value of HA was correlated with the histopathologic findings of liver biopsy in chronic hepatitis patients.

RESULTS: Serum HA increased significantly in chronic hepatitis cases compared with control. The mean serum HA was 111.22 mg/L for patients with chronic hepatitis B, 113.05 mg/L for hepatitis C, 112.30 mg/L for autoimmune hepatitis, and 33.96 mg/L for control group. Serum HA significantly increased in chronic hepatitis patients with stage 2 (p=0.0029) and stage 3 (p=0.0013) fibrosis compared with stage 0 (p=0.0054) fibrosis. Serum HA positively correlated with the degree of liver fibrosis, it increased significantly with stage 3 fibrosis (157.96 mg/L) compared with stage 2 fibrosis (122.13 mg/L) (p=0.0013).

CONCLUSION: Serum HA increased in chronic hepatitis, and its level correlates with the degree of fibrosis. Serum HA levels can be used for diagnosis and followed up of liver fibrosis in patients with chronic hepatitis.