Discriminant function based on hyaluronic acid and its degrading enzymes and degradation products for differentiating cirrhotic from non-cirrhotic liver diseased patients in chronic HCV infection

The invasive liver biopsy is still considered the gold standard for assessing patients with chronic hepatitis C (CHC). Our aim was to determine the operating characteristics of a non-invasive index based on blood biomarkers for the prediction of cirrhosis in CHC patients. Hyaluronic acid level was determined by radioimmuno-assay and its degrading enzymes and degradation products were determined by standard techniques in 153 patients with CHC with and without liver cirrhosis. Statistical analyses were performed by logistic regression, and receiver-operating characteristic (ROC) curves. The multivariate discriminant analysis (MDA) selected a function based on absolute values of five biochemical markers; Score = [1.63 + Hyaluronic acid (μg/l) × 0.001 + N-acetyl-β- d-glucosaminidase (μmol/ml/min) × 0.02 + glucuronic acid (μg/dl) × 0.015 + glucosamine (μg/dl) × 0.006 + AST/ALT ratio × 0.04]. The selected MDA function correctly classified 96% of the cirrhotic patients at a discriminant cut-off score = 2.5 (i.e. less than 2.5 indicated CHC without liver cirrhosis and greater than 2.5 indicated liver cirrhosis) with high degrees of sensitivity (95%) and specificity (97%). The positive predictive and negative predictive values were also high (95% and 97%, respectively). A patient with CHC can be simply and efficiently classified into cirrhotic or non-cirrhotic liver diseased patient using his or her MDA score.