Abstract

Hyaluronic Acid as a Serum Marker of Hepatic Fibrosis in Children Chronically Infected with Hepatitis C Virus

Author(s): Aisha A Sehari

Chronic hepatitis C is one of the major causes of liver disease throughout the world; nearly 170 million individuals are affected with the highest prevalence in Egypt. In Libya the prevalence of HCV was found to be 1.6 % among general population. The course and outcome of HCV infection is highly variable, form silent disease to development of cirrhosis and end stage liver disease. Most children with HCV progress to chronic HCV infection. Assessment of hepatic fibrosis is important for determining prognosis, guiding management decisions and monitoring disease. Histological evaluation of liver biopsy is currently considered the reference test for staging hepatic fibrosis. Since liver biopsy carries a small but significant risk; non-invasive methods to assess hepatic fibrosis are desirable. Among the non-invasive methods: serum markers, models and imaging which are easy to perform. Serum markers of fibrosis include, direct markers (ECM) proteins which reflect balance between fibrogenesis and fibrolysis turnover and indirect markers, which reflect alterations in hepatic function. In the present study author’s aim is to evaluate the diagnostic utility of hyaluronic acid (HA) in detecting the stage of fibrosis in children chronically infected with HCV. To achieve this goal, 60 chronically HCV infected and 25 healthy children were included in this study. All children were evaluated clinically. CBC, Liver profile, renal functions tests, Cholesterol, hyaluronic acid (HA) and Ultrasound (U/S) were done to all children (Cases and control). Percutaneous ultrasound guided liver biopsies were performed and classified according to Ishak scoring system in HCV infected children only. HCV studied children were divided into two groups; non-significant fibrosis (Stages 0/6, 1/6 and 2/6) and significant fibrosis (Stages 3/6 and 4/6). Statistical analysis of data obtained from the present study showed the following results: Patients and control group were age and sex matched; Only AST and ALT were higher in HCV children than control with significant difference and by using cut-off value of24μg/L one could predict absence or presence of significant fibrosis. Significant fibrosis can be predicted by a HA level of <24μg/l for its presence (PPV of 27.3%) and of <24μg/l for its absence (NPV of 100), with AUC of 0.747.