Limits...
Serum hyaluronic acid predicts protein-energy malnutrition in chronic hepatitis C

View Article: PubMed Central - PubMed

ABSTRACT

Serum hyaluronic acid (HA) is a well-established marker of fibrosis in patients with chronic liver disease (CLD). However, the relationship between serum HA level and protein-energy malnutrition (PEM) in patients with CLD is an unknown. We aimed to examine the relationship between serum HA level and PEM in patients with chronic hepatitis C (CHC) compared with the relationships of other serum markers of fibrosis. A total of 298 CHC subjects were analyzed. We defined patients with serum albumin level of ≤3.5 g/dL and nonprotein respiratory quotient <0.85 using indirect calorimetry as having PEM. We investigated the effect of serum HA level on the presence of PEM. Receiver operating characteristic curve (ROC) analysis was performed for calculating the area under the ROC (AUROC) for serum HA level, platelet count, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, and Forns index for the presence of PEM. The median serum HA level in this study was 148.0 ng/mL (range: 9.0–6340.0 ng/mL). In terms of the degree of liver function (chronic hepatitis, Child-Pugh A, B, and C), the analyzed patients were well stratified according to serum HA level (overall significance, P < 0.0001). The median value (range) of serum HA level in patients with PEM (n = 61) was 389.0 ng/mL (43.6–6340.0 ng/mL) and that in patients without PEM (n = 237) was 103.0 ng/mL (9.0–783.0 ng/mL) (P < 0.0001). Among 6 fibrosis markers, serum HA level yielded the highest AUROC with a level of 0.849 at an optimal cut-off value of 151.0 ng/mL (sensitivity 93.4%; specificity 62.0%; P < 0.0001). In the multivariate analysis, serum HA level was found to be a significant prognostic factor related to the presence of PEM (P = 0.0001).

In conclusion, serum HA level can be a useful predictor of PEM in patients with CHC.

No MeSH data available.


Related in: MedlinePlus

Receiver operating curve analyses of 6 fibrosis markers for the presence of PEM. (A) Serum hyaluronic acid level, (B) AST to platelet ratio index, (C) FIB-4 index, (D) AST to ALT ratio, (E) platelet count, and (F) Forns index. ALT = alanine aminotransferase, AST = aspartate aminotransferase, PEM = protein-energy malnutrition.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4998486&req=5

Figure 3: Receiver operating curve analyses of 6 fibrosis markers for the presence of PEM. (A) Serum hyaluronic acid level, (B) AST to platelet ratio index, (C) FIB-4 index, (D) AST to ALT ratio, (E) platelet count, and (F) Forns index. ALT = alanine aminotransferase, AST = aspartate aminotransferase, PEM = protein-energy malnutrition.

Mentions: Serum HA level yielded the highest AUROC, with a level of 0.849, at an optimal cut-off value of 151.0 ng/mL (sensitivity, 93.4%; specificity, 62.0%; P < 0.0001), followed by FIB-4 index (AUROC, 0.802; P < 0.0001), APRI (AUROC, 0.770; P < 0.0001), Forns index (AUROC, 0.762; P < 0.0001), platelet count (AUROC, 0.734; P < 0.0001), and AST to ALT ratio (AUROC, 0.724; P < 0.0001; Fig. 3 and Table 2A). In patients with a serum HA level of ≥151.0 ng/mL (n = 147), the proportion of PEM was 38.8% (57/147), whereas in patients with a serum HA level of <151.0 ng/mL (n = 151), the proportion of PEM was 2.65% (4/151) (P < 0.0001). When cut-off points of serum HA level were set at 300, 500, and 700 ng/mL, the proportions of PEM were 48.7% (38/78) in patients with HA level ≥300 ng/mL, 73.3% (22/30) in patients with HA level ≥500 ng/mL, and 87.5% (14/16) in patients with HA level ≥700 ng/mL. While in limited patients with LC (F4, n = 164), serum HA level also yielded the highest AUROC with a level of 0.771 at an optimal cut-off value of 443.0 ng/mL (sensitivity, 51.8%; specificity, 89.8%; P < 0.0001; Table 2B). In patients with a serum HA level of ≥443.0 ng/mL (n = 40), the proportion of PEM was 72.5% (29/40), whereas in patients with a serum HA level of <443.0 ng/mL (n = 124), the proportion of PEM was 21.8% (27/124) (P < 0.0001). In limited patients with non-LC (n = 134), APRI yielded the highest AUROC (0.854) and AUROC of serum HA level was 0.760 at an optimal cut-off value of 199.0 ng/mL (sensitivity, 60.0%; specificity, 91.5%; P < 0.0001; Table 2C). In patients with a serum HA level of ≥199.0 ng/mL (n = 14), the proportion of PEM was 21.4% (3/14), whereas in patients with a serum HA level of <199.0 ng/mL (n = 120), the proportion of PEM was 1.7% (2/120) (P = 0.0082).


Serum hyaluronic acid predicts protein-energy malnutrition in chronic hepatitis C
Receiver operating curve analyses of 6 fibrosis markers for the presence of PEM. (A) Serum hyaluronic acid level, (B) AST to platelet ratio index, (C) FIB-4 index, (D) AST to ALT ratio, (E) platelet count, and (F) Forns index. ALT = alanine aminotransferase, AST = aspartate aminotransferase, PEM = protein-energy malnutrition.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998486&req=5

Figure 3: Receiver operating curve analyses of 6 fibrosis markers for the presence of PEM. (A) Serum hyaluronic acid level, (B) AST to platelet ratio index, (C) FIB-4 index, (D) AST to ALT ratio, (E) platelet count, and (F) Forns index. ALT = alanine aminotransferase, AST = aspartate aminotransferase, PEM = protein-energy malnutrition.
Mentions: Serum HA level yielded the highest AUROC, with a level of 0.849, at an optimal cut-off value of 151.0 ng/mL (sensitivity, 93.4%; specificity, 62.0%; P < 0.0001), followed by FIB-4 index (AUROC, 0.802; P < 0.0001), APRI (AUROC, 0.770; P < 0.0001), Forns index (AUROC, 0.762; P < 0.0001), platelet count (AUROC, 0.734; P < 0.0001), and AST to ALT ratio (AUROC, 0.724; P < 0.0001; Fig. 3 and Table 2A). In patients with a serum HA level of ≥151.0 ng/mL (n = 147), the proportion of PEM was 38.8% (57/147), whereas in patients with a serum HA level of <151.0 ng/mL (n = 151), the proportion of PEM was 2.65% (4/151) (P < 0.0001). When cut-off points of serum HA level were set at 300, 500, and 700 ng/mL, the proportions of PEM were 48.7% (38/78) in patients with HA level ≥300 ng/mL, 73.3% (22/30) in patients with HA level ≥500 ng/mL, and 87.5% (14/16) in patients with HA level ≥700 ng/mL. While in limited patients with LC (F4, n = 164), serum HA level also yielded the highest AUROC with a level of 0.771 at an optimal cut-off value of 443.0 ng/mL (sensitivity, 51.8%; specificity, 89.8%; P < 0.0001; Table 2B). In patients with a serum HA level of ≥443.0 ng/mL (n = 40), the proportion of PEM was 72.5% (29/40), whereas in patients with a serum HA level of <443.0 ng/mL (n = 124), the proportion of PEM was 21.8% (27/124) (P < 0.0001). In limited patients with non-LC (n = 134), APRI yielded the highest AUROC (0.854) and AUROC of serum HA level was 0.760 at an optimal cut-off value of 199.0 ng/mL (sensitivity, 60.0%; specificity, 91.5%; P < 0.0001; Table 2C). In patients with a serum HA level of ≥199.0 ng/mL (n = 14), the proportion of PEM was 21.4% (3/14), whereas in patients with a serum HA level of <199.0 ng/mL (n = 120), the proportion of PEM was 1.7% (2/120) (P = 0.0082).

View Article: PubMed Central - PubMed

ABSTRACT

Serum hyaluronic acid (HA) is a well-established marker of fibrosis in patients with chronic liver disease (CLD). However, the relationship between serum HA level and protein-energy malnutrition (PEM) in patients with CLD is an unknown. We aimed to examine the relationship between serum HA level and PEM in patients with chronic hepatitis C (CHC) compared with the relationships of other serum markers of fibrosis. A total of 298 CHC subjects were analyzed. We defined patients with serum albumin level of &le;3.5&#8202;g/dL and nonprotein respiratory quotient &lt;0.85 using indirect calorimetry as having PEM. We investigated the effect of serum HA level on the presence of PEM. Receiver operating characteristic curve (ROC) analysis was performed for calculating the area under the ROC (AUROC) for serum HA level, platelet count, aspartate aminotransferase (AST) to platelet ratio index, FIB-4 index, AST to alanine aminotransferase ratio, and Forns index for the presence of PEM. The median serum HA level in this study was 148.0&#8202;ng/mL (range: 9.0&ndash;6340.0&#8202;ng/mL). In terms of the degree of liver function (chronic hepatitis, Child-Pugh A, B, and C), the analyzed patients were well stratified according to serum HA level (overall significance, P&#8202;&lt;&#8202;0.0001). The median value (range) of serum HA level in patients with PEM (n = 61) was 389.0&#8202;ng/mL (43.6&ndash;6340.0&#8202;ng/mL) and that in patients without PEM (n = 237) was 103.0&#8202;ng/mL (9.0&ndash;783.0&#8202;ng/mL) (P&#8202;&lt;&#8202;0.0001). Among 6 fibrosis markers, serum HA level yielded the highest AUROC with a level of 0.849 at an optimal cut-off value of 151.0&#8202;ng/mL (sensitivity 93.4%; specificity 62.0%; P&#8202;&lt;&#8202;0.0001). In the multivariate analysis, serum HA level was found to be a significant prognostic factor related to the presence of PEM (P = 0.0001).

In conclusion, serum HA level can be a useful predictor of PEM in patients with CHC.

No MeSH data available.


Related in: MedlinePlus