Abstract

Background: We aimed to investigate the utility of albumin-to-glutamyltransferase ratio (AGR) as a new biomarker to distinguish hepatic carcinoma from hepatitis, as early disease diagnosis, prognosis or monitoring could improve patient management and outcomes.
Methods: Clinical characteristics of 34 hepatitis (women 19), 88 cirrhosis (women 22) and 52 hepatic carcinoma (women 9) cases were retrospectively reviewed. Patients diagnosed with cirrhosis were classified by Child-Pugh score and the presence of ascites. The differences among groups were evaluated by the Kruskal-Wallis test and Mann-Whitney U. The linear correlation between variables was assessed by Spearman's correlation analysis. The diagnostic value of albumin-to-glutamyltransferase (AGR) was considered using receiver operating characteristic (ROC) curves. Multiple logistic regression analysis and univariate logistic regression analysis were used to identify AGR as an independent predictor in liver disease progression.
Results: The significant differences among the hepatitis vs. cirrhosis vs. and hepatic carcinoma were AST (108.50 ± 184.00 vs. 38.00 ± 21.50 vs. 47.00 ± 71.00, p < 0.01), TP/AST (TAR, 0.67 ± 0.69 vs. 1.77 ± 0.87 vs. 1.36 ± 0.95, p < 0.01), and ALB/GGT (AGR, 0.32 ± 0.27 vs. 0.67 ± 0.43 vs. 0.20 ± 0.26, p < 0.05). At the same time, AST (32.00 ± 13.50 vs. 53.00 ± 23.00 vs. 114.50 ± 42.50, p < 0.05) and TAR (2.15 ± 0.72 vs. 1.28 ± 0.74 vs. 0.64 ± 0.39, p < 0.05) were higher but AGR (0.86 ± 0.54 vs. 0.46 ± 0.32 vs. 0.26 ± 0.22, p < 0.05) was lower in Child-Pugh class C group compared with group B and C. TAR (1.92 ± 0.73 vs. 0.98 ± 0.89, p < 0.01) and AGR (0.79 ± 0.52 vs. 0.46 ± 0.28, p < 0.05) were significantly elevated in the serum of cirrhosis with no ascites compared with the cirrhosis patients suffered from ascites, while AST (35.00 ± 14.50 vs. 63.00 ± 44.50, p < 0.01) was reduced in cirrhosis patients with no ascites. Furthermore, AST (r = 0.4490, p<0.01) was positively correlated with AFP, TAR (r = -0.4393, p < 0.01) and AGR (r = -0.4395, p < 0.01) were negatively correlated with AFP. The ROC curve analysis for AST had an area under the curve (AUC) ranging from 0.66 to 0.82, TAR ranged from 0.64 to 0.80 and AGR ranged from 0.54 to 0.72. Multiple logistic regression analysis revealed AGR as an independent parameter to distinguish liver can¬cer to hepatitis, and AGR was associated with the presence of ascites and the progression in cirrhosis patients.
Conclusions: AGR is a potential biomarker for diagnosis of liver disease progression.

DOI: 10.7754/Clin.Lab.2019.190826