Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2864
Peer-review started: January 4, 2020
First decision: February 24, 2020
Revised: March 27, 2020
Accepted: May 28, 2020
Article in press: May 28, 2020
Published online: June 7, 2020
Assessing liver fibrosis is important for predicting the efficacy of direct-acting antivirals (DAAs) and patient prognosis. Non-invasive techniques to assess liver fibrosis are becoming important. Recently, serum Mac-2 binding protein glycosylation isomer (M2BPGi) was identified as a non-invasive marker of liver fibrosis.
The approval of DAAs was a revolution in hepatitis C virus eradication, with sustained virologic response (SVR) rates exceeding 90%. However, a few reports have documented the improvement in liver fibrosis in patients treated with DAAs. Although liver biopsy is considered the gold standard for stratifying hepatic fibrosis, its clinical utility is substantially limited because of the invasiveness and the sampling variability. Accordingly, serum M2BPGi was evaluated as a non-invasive marker for assessing the grade of hepatic fibrosis in patients who have achieved SVR after antiviral therapy.
We aimed to investigate the diagnostic accuracy of serum M2BPGi levels in assessing the grade of liver fibrosis in patients with chronic hepatitis C (CHC) before and after DAAs-based treatment, as well as to compare its diagnostic value with the FIB-4 score and PAPAS index.
Eighty treatment-naïve adult patients with CHC who were eligible for DAAs therapy were consecutively enrolled in this observational cohort study. For 12 weeks, 65 patients were treated with sofosbuvir/daclatasvir, and 15 patients were treated with sofosbuvir/daclatasvir and a weight-based dose of ribavirin. We measured serum M2BPGi levels, PAPAS index, FIB-4 score and liver stiffness measurements (LSM) at baseline and 12 weeks after the end of treatment. Serum M2BPGi levels were measured using enzyme-linked immunosorbent assay.
All patients achieved SVR12 (100%). Serum M2BPGi levels, LSM, FIB-4 score and PAPAS index decreased significantly at SVR12 (P < 0.05). Serum M2BPGi levels correlated positively with LSM at baseline and SVR12 (P < 0.001). At baseline, compared with the FIB-4 score and PAPAS index, M2BPGi was the best marker to distinguish patients with grade F4 fibrosis (AUC = 0.801, P < 0.001), patients with grade F2 from grade F0-1 fibrosis (AUC = 0.713, P = 0.012), patients with grade F3-4 from grade F0-2 fibrosis (AUC = 0.730, P < 0.001), and patients with grade F2-4 from grade F0-1 fibrosis (AUC = 0.763, P < 0.001). At SVR12, M2BPGi had the greatest AUCs for differentiating patients with grade F4 fibrosis (AUC = 0.844, P < 0.001), patients with grade F3 from grade F0-2 fibrosis (AUC = 0.893, P = 0.002), patients with grade F3-4 from grade F0-2 fibrosis (AUC = 0.891, P < 0.001), and patients with grade F2-4 from grade F0-1 fibrosis (AUC = 0.750, P < 0.001).
M2BPGi is a reliable marker for the non-invasive assessment and prediction of liver fibrosis regression in patients with CHC who achieved an SVR with DAAs therapy.
Non-invasive methods have been previously proposed and validated for the assessment of hepatic fibrosis. In this study, we confirm that serum M2BPGi is a reliable marker for liver fibrosis. Further studies are needed to investigate its therapeutic potential and ultimate clinical utility.