Serum Leucine‐Rich α2‐Glycoprotein 1 Identifies Cachexia in Patients With Liver Cirrhosis and/or Hepatocellular Carcinoma Having Low C‐Reactive Protein Levels

AIM: Cachexia in liver cirrhosis (LC) and hepatocellular carcinoma (HCC) is associated with poor outcomes. Although C-reactive protein (CRP) is used for diagnosis, its limited specificity may hinder detection of cachexia without systemic inflammation. Leucine-rich α2-glycoprotein 1 (LRG1) may identify cachexia when CRP is low; however, its significance in LC and HCC remains unclear. METHODS: We retrospectively enrolled 243 patients with LC and/or HCC. Cachexia was defined according to the Asian Working Group for Cachexia criteria. Serum LRG1 levels were measured, and associations with cachexia, CRP, and survival were analyzed. Receiver operating characteristic curve analysis determined the optimal LRG1 cutoff. RESULTS: Cachexia, observed in 65 patients (26.7%), was independently associated with shorter survival. Serum LRG1 levels were higher in patients with cachexia than in those without (median, 16.70 vs. 11.55 μg/mL; p < 0.001). Although LRG1 correlated with CRP, high LRG1 was observed in some patients with low CRP. In multivariable analysis, LRG1 remained independently associated with cachexia (odds ratio, 1.060; 95% confidence interval, 1.000-1.130; p = 0.045). The optimal LRG1 cutoff was 15.2 μg/mL; cachexia was more frequent in patients with high LRG1 than in those without (48.75% vs. 15.95%, p < 0.001). Among patients with cachexia having low CRP, 37.5% had high LRG1. In the low-CRP subgroup, LRG1 remained independently associated with cachexia. CONCLUSIONS: Serum LRG1 is associated with cachexia in LC and/or HCC and may provide clinically relevant information not captured by CRP. LRG1 assessment may improve recognition and stratification of cachexia, even in patients with low CRP levels.