Accuracy of hyaluronic acid level for predicting liver fibrosis stages in patients with hepatitis C virus

405 patients with chronic hepatitis C were prospectively included with biomarker measurement and liver biopsy done the same day: 151 in the training set (only biopsy lengths of 25 mm or more) and 254 in the validation set. For the discrimination of significant fibrosis, severe fibrosis, and cirrhosis in the training set, the areas under curve (AUCs) were 0.75 ± 0.03, 0.82 ± 0.02, and 0.89 ± 0.03, respectively. Absence of significant fibrosis, severe fibrosis, and cirrhosis can be predicted by HA levels of 16, 25, and 50 μg/l, respectively (with negative predictive values of 82%, 89%, and 100%, in the same order). Presence of significant fibrosis, severe fibrosis, and cirrhosis can be predicted by HA levels of 121, 160, and 237 μg/l, respectively (with positive predictive values of 94%, 100%, and 57%, in the same order).In the validation set, HA was accurate in predicting significant fibrosis, severe fibrosis, and cirrhosis with AUCs of 0.73, 0.77, and 0.97, respectively. Moreover, accurate HA level cut-offs were defined for predicting significant fibrosis, severe fibrosis, and cirrhosis. Thus, the study supports that HA level may be clinically useful as a non-invasive marker for liver fibrosis and/or cirrhosis.Liver biopsy is currently recommended as the gold standard method of staging fibrosis in patients with chronic hepatitis C [1,2]. The risk of developing cirrhosis depends on the stage (degree of fibrosis) and the grade (degree of inflammation and necrosis) observed in the initial liver biopsy [3,4]. This procedure, however, is invasive and has potential complications [5,6]. Non-invasive approaches developed to assess histological samples include clinical symptoms, routine laboratory tests, and radiolographic imaging [7-10]. Several clinical studies have attempted to identify serum markers that correlate with the degree of fibrosis and thus could be used, with feasibility, in conjunction with or in place of a liver biopsy [2-4,6,8,9]. The serum markers of fibro