Diagnosis Value Of Serum Hyaluronic Acid For Liver Fibrosis In Patients With Chronic Viral Hepatitis: A Systematic Review

Objective 1. To evaluate the quality of the current studies involving the value of serum hyaluronic acid in the diagnosis of liver fibrosis with chronic viral hepatitis, analyze the sources of bias and variation. 2. To estimate the accuracy of serum hyaluronic acid in diagnosing early liver cirrhosis, identifying mild and severe liver fibrosis, discriminating absence and presence liver fibrosis in patients with chronic viral hepatitis.Method We comprehensive collected current studies about serum HA to diagnosis liver fibrosis on chronic hepatitis by computer and manual searchesQUADAS items were used for quality assessment in our systematic review. Meta-disc software was used to analyze sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio, diagnostic test odds ratio for the pooled analysis and heterogeneity test, and draw SROC curves.Results Totally 27 studies were included, 15 Chinese studies and 12 English studies.27 studies had better control the bias from partial verification, differential verification, withdrawals. And the reference standard review bias because of the subjective of liver histopathology could have a greater bias as the absence of implementation of the blind. To analyze from disease progression bias, because of the slow progression in chronic viral hepatitis, there was actual less likely to bias. Only three of the 27 papers had information on the status of the epidemic, but there was not reported the prevalence rate. In addition to selection criteria and exclusion criteria in a study was poorly described in 27 studies. About reporting quality, the methods, reagents of HA were always reported in 27 studies, that the rest of the reports were not comprehensive. Specifically, there was lack of reporting positive cut-off value. And there was lack of reporting reference standard execution. The worst was that there was not about reporting uninterpretable test results in 27 studies. The quality of English studies was generally better to the quality Chinese studies.In statistical analysis, to diagnosis early liver cirrhosis, identify mild and severe liver fibrosis, discriminate absence and presence liver fibrosis, pooled sensitivity was diagnosis early liver cirrhosis(0.82),discriminate absence and presence liver fibrosis(0.65),identify mild and severe liver fibrosis(0.52); pooled specificity was identify mild and severe liver fibrosis(0.89),diagnosis early liver cirrhosis(0.87),discriminate absence and presence liver fibrosis(0.77), respectively. In two methods to test HA, pooled sensitivity was RIA(0.78), EIA(0.58), pooled specificity was EIA(0.88), RIA(0.83).Conclusion Therefore, the bias was mainly not implemented blind to reference standard review in the 27 studies. Reporting quality of the studies was worried. The studies presented the larger variation. Variations were mainly from the choice of the objects of diseases, medical environment, et al.The results of statistical analysis showed that the value to diagnosis liver cirrhosis of serum HA was best. The value to exclude liver fibrosis in discriminating absence and presence liver fibrosis can also accepted. Therefore, to the two detection methods of identifying mild and severe liver fibrosis, we could not get reliable conclusions. The results of two test methods of serum HA had showed that RIA and EIA had same diagnostic accuracy.