Fucosylated α-1-acid glycoprotein as a noninvasive fibrosis marker in chronic viral hepatitis

We have previously developed a potential non-invasive fibrosis marker in the form of a lectin immunoassay for the detection of fucosylated α1-acid glycoprotein in plasma (P-AGP-FR). We aimed to investigate the diagnostic accuracy of P-AGP-FR for liver cirrhosis and fibrosis in a clinical setting of patients with chronic viral hepatitis. One hundred twenty-four patients, 80 with chronic hepatitis B and 44 with chronic hepatitis C, were recruited at two centers. P-AGP-FR levels were evaluated in relation to fibrosis or cirrhosis according to liver biopsy or transient elastography, and its diagnostic accuracy was compared with other noninvasive biochemical fibrosis markers; APRI and FIB-4. AGP fucosylation was elevated in patients with fibrosis, and the correlation of P-AGP-FR values with fibrosis levels was significant in all groups. The probability for fibrosis increased with higher P-AGP-FR values, with an odds ratio (OR) of 2.79. Receiver operating characteristic (ROC) curve analysis was done for the diagnostic accuracy of P-AGP-FR for fibrosis according to biopsy and liver elastography, respectively. Area under the ROC curve (AUROC) was 0.74 (95% CI: 0.58-0.91) for fibrosis according to biopsy and 0.72 (95% CI: 0.58-0.85) for fibrosis according to liver elastography. Optimal cutoff by Youden for fibrosis according to liver biopsy was 1.95, sensitivity 63.6% and specificity 85.7%. For fibrosis according to liver elastography, optimal cutoff was 1.44, sensitivity 54.6% and specificity 78.8%. In conclusion, AGP fucosylation measured as P-AGP-FR was significantly higher in patients with hepatic fibrosis and cirrhosis, and we found a significant correlation between P-AGP-FR and fibrosis stage.