Changes in serum levels of leucine-rich α2-glycoprotein predict prognosis in primary biliary cholangitis

Aims A non-invasive biomarker for patients with primary biliary cholangitis (PBC) is needed. The association between leucine-rich alpha 2 glycoprotein (LRG) and PBC has not been investigated. We aimed to assess the predictive value of LRG for the development of cirrhosis-related conditions in PBC. Methods We retrospectively reviewed clinical data of 129 individuals with biopsy-confirmed PBC. Leucine-rich alpha 2 glycoprotein was analyzed by enzyme-linked immunosorbent assays using stored sera at biopsy (n = 129) and after treatment (n = 80). Results Levels of LRG decreased significantly after treatment (55.8 mu g/mL vs. 39.8 mu g/mL, P < 0.001). Neither LRG nor delta-LRG was associated with transaminase or histological findings. Delta-LRG >0 (hazard ratio [HR] 4.61, P = 0.013), delta-LRG >0 and an aspartate aminotransferase/platelet ratio index (APRI) >0.76 (HR 458, P < 0.001) were associated with the development of a cirrhosis-related condition. Patients with a delta-LRG >0 and an APRI >0.76 had a significantly increased rate of developing cirrhosis-related conditions (P < 0.001). Conclusions Changes in LRG levels after treatment predicted PBC prognosis but were not associated with histological stage. Changes in LRG in addition to the APRI could be a useful combination of tools for clinicians as a non-invasive biomarker.