Prognostic value of anti-gp210 antibodies in primary biliary cholangitis: A Systematic review and meta-analysis

Background: Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease characterized by portal inflammation and immune-mediated nonsuppurative destructive cholangitis. Recent studies have shown that anti-gp210 antibodies are associated with the prognosis of PBC. Here, we conducted a pooled analysis of the relationship between anti-gp210 antibodies and the prognosis of PBC patients to identify high-risk patients early and provide individualized interventions. Methods: PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched until January 2025. A meta-analysis was undertaken using a fixed-effects model and 95% confidence interval (CI) when no statistically significant heterogeneity existed; otherwise, a random-effects statistical model was used. Results: A total of 12 records were included in this systematic review and meta-analysis. The results of our meta-analysis showed that anti-gp210 positive PBC patients had a higher incidence of liver failure (relative risk (RR), 6.11; 95% CI, 3.16–11.81) and mortality (RR, 1.92; 95% CI, 1.55–2.37) and a lower ursodeoxycholic acid (UDCA) response rate (RR, 0.81; 95% CI, 0.73–0.89) compared with anti-gp210 negative patients. Moreover, the presence of anti-gp210 antibodies was independently associated with a poor prognosis in patients with PBC (hazard ratios (HR), 4.53; 95% CI, 2.83–7.26). In addition, anti-gp210 positive PBC patients had higher serum gamma-glutamyl transpeptidase (GGT) (mean difference (MD), 53.03; 95% CI, 3.70–102.36), immunoglobulin M (IgM) (MD, 1.29; 95% CI, 0.80–1.78), and immunoglobulin G (IgG) (MD, 1.06; 95% CI, 0.07–2.06) levels and lower albumin (MD, −1.74; 95% CI, −2.80 to − 0.69) levels. Conclusion: In conclusion, PBC patients with positive anti-gp210 have a worse prognosis than those with negative anti-gp210. Incorporating anti-gp210 testing into clinical practice could enhance risk stratification and guide personalized management, ultimately improving outcomes for this vulnerable population.