Diagnostic Accuracy of Serum Hyaluronic Acid, FIBROSpect II, and YKL-40 for Discriminating Fibrosis

April 5, 2008

The American Journal of Gastroenterology 103 (4) , 928¨C936

doi:10.1111/j.1572-0241.2007.01761.x

Abstract

Diagnostic Accuracy of Serum Hyaluronic Acid, FIBROSpect II, and YKL-40 for

Discriminating Fibrosis Stages in Chronic Hepatitis C

Preeti Mehta, M.D.11Department of Medicine, State University of New York,

Upstate Medical University, Syracuse, New York, Ploutz-Snyder,

Ph.D.11Department of Medicine, State University of New York, Upstate Medical

University, Syracuse, New York, Jyotirmoy Nandi, Ph.D.11Department of Medicine,

State University of New York, Upstate Medical University, Syracuse, New York,

Sekou R. Rawlins, M.D.11Department of Medicine, State University of New York,

Upstate Medical University, Syracuse, New York, Schuyler O. on,

M.D.22Division of Anatomic Pathology, Mayo Clinic College of Medicine,

Rochester, Minnesota, and A. Levine, M.D.11Department of Medicine, State

University of New York, Upstate Medical University, Syracuse, New

York1Department of Medicine, State University of New York, Upstate Medical

University, Syracuse, New York; and 2Division of Anatomic Pathology, Mayo Clinic

College of Medicine, Rochester, Minnesota

Reprint requests and correspondence: A. Levine, M.D., Division of

Gastroenterology, Department of Medicine, SUNY Upstate Medical University, 750

East Street, Syracuse, NY 13210.

(Am J Gastroenterol 2008;103:928¨C936)

Abstract

OBJECTIVES: Noninvasive serum markers of liver fibrosis are being used as an

alternative to liver biopsy. Currently available tests distinguish, with

accuracy, only absent/minimal fibrosis (Ishak stages 0¨C1) and advanced

fibrosis/cirrhosis (Ishak stages 4¨C6), but not intermediate fibrosis (Ishak

stages 2¨C3). Our aim was to evaluate the diagnostic accuracy of hyaluronic acid

(HA), FIBROSpect II (FS-II), and YKL-40 (chondrex, human cartilage

glycoprotein-39) in various clinically important categories of fibrosis, and

further correlate these serum markers with digital quantification of fibrosis

(DQF) and Ishak stages.

METHODS: Serum HA, YKL-40, and FS-II were retrospectively assessed and

correlated with Ishak stages and DQF scores in 75 patients with chronic

hepatitis C (HCV). Spearman's rho statistics assessed relationships among all

parameters, and receiver operator characteristic curves evaluated accuracy of

each parameter when compared to the Ishak stages.

RESULTS: All three serum markers and DQF correlated highly with one another (P

¡Ü 0.01) and with Ishak stages of fibrosis. Among the serum markers, HA was

effective in discriminating between Ishak stages 0¨C1 and Ishak stages 2¨C3

compared with FS-II, with an area under the curve of 0.76 versus 0.66 and a

false-positive rate of 0.33 versus 0.67, respectively. All three serum markers

predicted advanced fibrosis and cirrhosis. YKL-40 had the highest false-positive

rates in all categories of fibrosis.

CONCLUSIONS: HA can be utilized as a reliable surrogate marker in

distinguishing three clinically relevant stages of fibrosis: absent/minimal,

intermediate, and advanced/cirrhosis. HA should be considered as a

cost-effective alternative to other serum markers for staging fibrosis and for

determining the timing and selection of HCV treatment.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2007.01761.x

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April 5, 2008