Diagnostic Value of Anti-gp210 Combined with Indirect Serum Markers for Predicting Histological Staging in Patients with Primary Biliary Cholangitis

Abstract

Background: Diagnosis of the histological stage in primary biliary cholangitis (PBC) is essential for prognosis and further therapy. Noninvasive markers of liver fibrosis in PBC remain compelling. This study aimed to validate the diagnostic value of AST to ALT ratio (AAR), AST-to-platelet ratio index (APRI), and fibrosis index based on 4 factors (FIB-4) in predicting histological severity among PBC patients combined with anti-gp210. Methods: A total of 208 PBC patients receiving liver biopsy with complete serological tests were enrolled. Clinical data including AAR, APRI and FIB-4 were compared with histological stage. Receiver operating characteristic analyses (ROCs) were used to assess the sensitivity and specificity of these markers with or without anti-gp210 in estimating liver fibrosis. Findings: The scores of AAR, APRI, and FIB-4 increased significantly according to the Ludwig's stage. Anti-gp210 was independently associated with liver fibrosis. The areas under the ROCs (AUCs) of AAR, APRI and FIB-4 combined with anti-gp210 for predicting advanced stage were 0.798, 0.816 and 0.834, respectively, which were superior to the AUCs of these markers predicting alone. The AUCs of AAR, APRI and FIB-4 for predicting advanced stage in the anti-gp210 positive patients were 0.748, 0.812 and 0.874, respectively. Using the best cutoff values of AAR, APRI, and FIB-4, 36.5%, 34.3% and 51.3% of patients could avoid liver biopsy, respectively. Interpretation: Indirect serum markers AAR, APRI, and FIB-4 represented a simple and reliable noninvasive surrogate marker of liver fibrosis especially in anti-gp210 positive PBC patients. Funding Statement: National Key Technology R&D Programme (2015BAI13B07). Declaration of Interests: All the authors declare no competing interests. Ethics Approval Statement: The study was conducted in accordance with the Declaration of Helsinki and was approved by the Fourth Military Medical University. Informed consent was obtained in writing from each patient, and the study protocol was approved by the ethical committee of the Fourth Military Medical University