To define hepatic predictors of serum hydurorian in patients with chronic liver disease, 62 patients with alcoholic liver disease were evaluated. In group 1, 30 patients had concurrent assessment of serum hyaluronan, liver function tests, Pugh grade and heinodynamic indices. A second, overlapping group of 42 patients (group 2) also had antipyrine clearance measured but without hemodynamic assessment. All btut six patients had elevated serum hyaluronan levels. In both groups, serum hyaluronan levels differed between Pugh grades and, in each group, was significantly greater in Pugh grade C compared with those in Pugh grade A (p < 0.05, Kruskal-Wallis test). When analyzed by correlation, serum hyaluronan was Significantly associated with several indices in group 1, but on multivariate linear regression only three statistically independent predictors of serum hyaluronan were identified serum albumin (p = O.OOS), indocyanine green clearance (p = 0.024) and indocyanine green extraction (p = 0.036). The overall R2 for these correlates was 65%. In the second group, antipyrine clearance was not significantly associated with serum hyaluronan (r = 0.29, p = 0.06), but other associations were similar to the first group. On multivariate analysis, only serum albumin predicted serum fiyaluronan (p < 0.001; R2 = 43%). In conclusion, indices of hepatocyte synthetic function, sinusoidal blood. flow and degree of intrahepatic shunting are independent predictors of serum hyaluronan in alcoholic liver disease. These data show the unique nature of serum hyaluronan and suggest its potential application l,o the assessment of acute hemodynamic changes in patients with liver disease. (HEPATOLOGY 1992;15:1054-1059.)
Hyaluronan (hyaluronic acid, hyaluronate, HA) is an unbranched high molecular weight polysaccharide that is present in the matrix of virtually every tissue in the body. HA released from connective tissue is transported by way of lymphatic vessels to the blood stream (1). Its