Fibroblast growth factor 19 in combination with liver fibrosis markers for non-invasive diagnosis of primary biliary cholangitis-associated cirrhosis.

Background And Aims: Primary biliary cholangitis (PBC) is an autoimmune liver disease that can progress to cirrhosis. However, reliable non-invasive tools for early cirrhosis risk stratification are still lacking. This study aimed to assess the diagnostic performance of fibroblast growth factor 19 (FGF19) in combination with the conventional liver fibrosis markers-aspartate aminotransferase-to-platelet ratio index(APRI), fibrosis-4 index(FIB-4), hyaluronic acid (HA), procollagen III N-terminal propeptide (PIIINP), collagen type IV (CIV), and laminin (LN) in PBC-associated cirrhosis.

Methods: This retrospective cohort study enrolled 164 PBC patients (68 with cirrhosis, 96 without cirrhosis) and 101 healthy controls. Serum levels of FGF19, HA, PIIINP, CIV, and LN were measured. APRI and FIB-4 were calculated using routine laboratory data. A diagnostic model was constructed using logistic regression and receiver operating characteristic (ROC) analysis.

Results: Cirrhosis patients exhibited significantly elevated FGF19, APRI, FIB-4, HA, and CIV levels compared to non-cirrhosis patients (P < 0.01). FGF19 demonstrated strong positive correlations with APRI, FIB-4, HA, and CIV, with the highest correlation observed for FIB-4. ROC analysis revealed that FGF19 alone had excellent diagnostic accuracy for cirrhosis (AUC = 0.938, 95 % CI: 0.900-0.976). Notably, a multi-marker panel (FGF19 + HA + CIV + APRI + FIB-4) achieved superior performance (AUC = 0.983, 95 % CI: 0.969-0.997), outperforming individual biomarkers.

Conclusions: Serum FGF19 is a promising biomarker for cirrhosis risk stratification in PBC. Its integration with traditional fibrosis markers significantly improves diagnostic accuracy and holds promise as a non-invasive tool for the differential diagnosis of cirrhosis in patients with PBC.