Evaluating thresholds of Mac-2 binding protein glycosylation isomer in association with clinical outcomes in patients with cirrhosis

BACKGROUND Cirrhosis is a progressive condition characterized by fibrosis that can lead to severe complications and increased mortality. The mac-2 binding protein glycosylation isomer (M2BPGi) is a prominent biomarker for predicting hepatocellular carcinoma (HCC) and cirrhosis-induced esophageal varices (EV). AIM To investigate thresholds of M2BPGi associated with HCC, EV, and decompensation in patients with cirrhosis. METHODS This was a prospective study. A total of 153 patients with cirrhosis who met the inclusion criteria were enrolled. The patients were diagnosed with HCC and EV according to the Baveno VII and European Association for the Study of the Liver guidelines. Baseline serum M2BPGi levels were assessed along with other routine tests. The data analysis aimed to determine the cutoff values of M2BPGi for predicting EV and HCC. RESULTS In the study 85.6% of patients were Child-Pugh B and C. M2BPGi mean cutoff index was 7.1 ± 3.7, showing no significant etiological differences. However, M2BPGi levels varied significantly among Child-Pugh classes, EV classifications, and between patients with and without HCC (P < 0.01). M2BPGi cutoff values for predicting HCC, EV, and decompensated cirrhosis were 6.50, 6.64, and 5.25, respectively. Multivariate analysis confirmed M2BPGi as an independent risk factor for EV [adjusted odds ratio (aOR): 1.3, 95%CI: 1.08-1.64] and liver decompensation (aOR: 2.11, 95%CI: 1.37-3.83). Area under the curve of M2BPGi for HCC differentiation was 0.71. An algorithm combining alpha-fetoprotein (AFP) and M2BPGi detected 26 of 28 HCC cases with 98.04% accuracy vs 10 cases by AFP alone. CONCLUSION Serum M2BPGi predicted cirrhosis complications, including decompensation and varices, especially in HCC. Combined with AFP, it enhanced HCC detection. Future liver biopsy studies are needed for tissue confirmation.