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High biological variation of serum hyaluronic acid and Hepascore, a biochemical marker model for the prediction of liver fibrosis

  • Enrico Rossi EMAIL logo , Leon A. Adams , Helena L. Ching , Max Bulsara , Gerry C. MacQuillan and Gary P. Jeffrey
Published/Copyright: November 8, 2012
Clinical Chemistry and Laboratory Medicine
From the journal Clinical Chemistry and Laboratory Medicine Volume 51 Issue 5

Abstract

Background: Serum hyaluronic acid and biochemical models which require hyaluronic acid analysis are commonly used as predictors of liver fibrosis in patients with chronic liver disease, however biological variation data for hyaluronic acid are deficient.

Methods: Four serial serum samples were obtained at weekly intervals from healthy volunteers and patients with chronic hepatitis B, chronic hepatitis C and non- alcoholic fatty liver disease (NAFLD; 20 in each group). The within-individual week-to-week variation (CVI) and reference change values for hyaluronic acid, α2-macroglobulin and Hepascore were obtained. Hepascore is calculated from hyaluronic acid, α2-macroglobulin, bilirubin and γ-glutamyltransferase activity.

Results: Hyaluronic acid displayed large within-individual variation, the CVI values were 62% in healthy subjects, 38% in hepatitis C, 37% in hepatitis B and 36% in NAFLD patients. Hepascore CVIs were 43% in healthy subjects, 24% in hepatitis C, 28% in hepatitis B and 39% in NAFLD patients. α2-Macroglobulin was much less variable with CVIs ranging from 4.4% to 7.6%. Bland-Altman plots of week-to-week variations showed rates of significant disagreement for samples collected in any 2 successive weeks varied from 5% in NAFLD patients to 8.3% in healthy subjects.

Conclusions: When using non-fasting serum samples, hyaluronic acid and to a lesser extent, the Hepascore model display large within-individual variations in both health and chronic liver disease. This information is critical for interpreting the significance of both single measurements and changes in serial measurements.

Keywords: Hepascore; hyaluronic acid; liver fibrosis; reference change value; within-individual variation
Corresponding author: Dr. Enrico Rossi, Biochemistry, PathWest, QE II Medical Centre, Nedlands, Western Australia, Australia

We gratefully acknowledge the efforts of PathWest QE II medical scientists in the Special Chemistry section who performed the required laboratory tests.

Conflict of interest statement

Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article.

Research funding: None declared.

Employment or leadership: None declared.

Honorarium: None declared.

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Received: 2012-9-6
Accepted: 2012-10-4
Published Online: 2012-11-08
Published in Print: 2013-05-01

©2013 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm-2012-0584
Keywords for this article
Hepascore; hyaluronic acid; liver fibrosis; reference change value; within-individual variation

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorial
  4. Progress towards standardization: an IFCC Scientific Division Perspective
  5. Review
  6. Quantitative Clinical Chemistry Proteomics (qCCP) using mass spectrometry: general characteristics and application
  7. Mini Reviews
  8. Analytical goals for the determination of HbA2
  9. Glucose meters – fit for clinical purpose
  10. Opinion Papers
  11. Metrological traceability – a concept for standardization in laboratory medicine
  12. Recommendations for clinical laboratory science reports regarding properties, units, and symbols: the NPU format1)
  13. “Good samples make good assays” – the problem of sourcing clinical samples for a standardization project
  14. Defining acceptable limits for the metrological traceability of specific measurands
  15. Original Articles
  16. A reference system for urinary albumin: current status
  17. Toward standardization of carbohydrate-deficient transferrin (CDT) measurements: III. Performance of native serum and serum spiked with disialotransferrin proves that harmonization of CDT assays is possible
  18. External Quality Assessment Scheme for reference laboratories – review of 8 years’ experience
  19. Utility of a panel of sera for the alignment of test results in the worldwide multicenter study on reference values
  20. Protocol and standard operating procedures for common use in a worldwide multicenter study on reference values
  21. Guidelines and Recommendations
  22. 2013 update on the worldwide standardization of the hemoglobin A1c measurement
  23. General Clinical Chemistry and Laboratory Medicine
  24. Evacuated blood-collection tubes for haematological tests – a quality evaluation prior to their intended use for specimen collection
  25. Refrigeration is not necessary for measurement of uric acid in patients treated with rasburicase
  26. Procalcitonin and mid-regional pro-adrenomedullin test combination in sepsis diagnosis
  27. Cysteinyl leukotrienes in exhaled breath condensate of smoking asthmatics
  28. Helicobacter pylori serology in autoimmune diseases – fact or fiction?
  29. Serum DNase I activity in systemic lupus erythematosus: correlation with immunoserological markers, the disease activity and organ involvement
  30. Antibodies against Nε-homocysteinylated proteins in patients on different methods of renal replacement therapy
  31. Reference Values and Biological Variations
  32. Reference values for urinary neutrophil gelatinase-associated lipocalin (NGAL) in pediatric age measured with a fully automated chemiluminescent platform
  33. High biological variation of serum hyaluronic acid and Hepascore, a biochemical marker model for the prediction of liver fibrosis
  34. Cardiovascular Diseases
  35. Circulating matrix Gla protein: a potential tool to identify minor carotid stenosis with calcification in a risk population
  36. Midregional pro-atrial natriuretic peptide in the general population/Insights from the Gutenberg Health Study
  37. Letters to the Editor
  38. Relationship between Helicobacter pylori infection and autoimmune disorders
  39. Rapid simultaneous genotyping of polymorphisms in ADH1B and ALDH2 using high resolution melting assay
  40. Comparison of biological specimens and DNA collection methods for PCR amplification and microarray analysis
  41. Transferrin/log(ferritin) ratio: a self-fulfilling prophecy when iron deficiency is defined by serum ferritin concentration
  42. Response to: Transferrin/log(ferritin) ratio: a self-fulfilling prophecy when iron deficiency is defined by serum ferritin concentration
  43. Determinants of homocysteine concentrations in mother and neonatal girl pairs
  44. Cysteine analog breaks cryoprecipitate associated with chronic hepatitis C
  45. Cut-off values of serum growth hormone (GH) in pharmacological stimulation tests (PhT) evaluated in short-statured children using a chemiluminescent immunometric assay (ICMA) calibrated with the International Recombinant Human GH Standard 98/574
  46. Normalized MEDx chart as a useful tool for evaluation of analytical quality achievements. A picture is worth a thousand words
  47. Harmonization of immunoassays to the all-procedure trimmed mean – proof of concept by use of data from the insulin standardization project
  48. Congress Abstracts
  49. Annual Assembly of the Swiss Society of Clinical Chemistry & International Congress of Porphyrins and Porphyrias & International Meeting of Porphyria Patients: Personalized Medicine and Rare Diseases
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