Abstract

Aim: While alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bile acids (TBA) have been implicated for monitoring liver injury in liver diseases, the role of glycocholic acid (GCA) as a biomarker for liver injury is underexplored. This study aims to assess the potential value of CGA in liver diseases.

Methods: Serum levels of GCA, ALT, AST, and TBA were detected and analyzed in 240 patients with liver disease [80 hepatocellular carcinoma (HCC), 80 liver cirrhosis, and 80 Chronic Hepatitis B (CHB)] and in 80 healthy subjects. Receiver-operating characteristic (ROC) curves were used to analyze. Further, the correlations of GCA with AST, ALT, and TBA were examined.

Results: The serum levels of GCA, ALT, AST, and TBA in patients with liver disease were higher than those in healthy subjects. The areas under the receiver-operating characteristic curves (AUROCs) of the GCA in liver disease was 0.882 [95% confidence interval (CI): 0.842 - 0.915], which was higher than that of ALT [0.645 (95%CI: 0.589 - 0.697)] (P < 0.0001), AST [0.745 (95%CI: 0.693 -0.792)] (P < 0.0001) and TBA [0.811 (95%CI: 0.764 - 0.853)] (P = 0.0044). When GCA was combined with the ALT, AST, and TBA for liver disease, the combined AUROCs increased, with values of 0.909 (95%CI: 0.872 - 0.938) (P = 0.0107). When healthy subjects served as controls, the AUROCs of the GCA in HCC patients, liver cirrhosis patients, and CHB patients were 0.889 [95% CI: 0.830 - 0.933], 0.959 [95% CI: 0.916 - 0.984], and 0.798 [95% CI: 0.727 - 0.857], respectively. When GCA was combined with the ALT, AST, and TBA for HCC, the AUROCs increased, with values of 0.967 (95%CI: 0.926 - 0.989) (P = 0.0014). Serum levels of GCA in HCC patients were significantly lower than those in liver cirrhosis patients (P =0.0014) and were higher than those in CHB patients (P < 0.0001). When CHB served as controls, the AUROC of GCA alone was 0.704 [95% CI: 0.627 - 0.774] for HCC and 0.813 [95% CI: 0.743 - 0.870] for liver cirrhosis. GCA was positively correlated with serum levels of ALT, AST, and TBA (Kendall's Tau = 0.155, P<0.0001; Kendall's Tau =0.304, P<0.0001; and Kendall's Tau = 0.453, P<0.0001, respectively).

Conclusions: GCA may be more useful than ALT, AST, and TBA for monitoring liver injury in liver diseases. It was positively correlated with serum levels of ALT, AST, and TBA. GCA monitoring can be applied in the differentiation of liver disease, in the selection of patients for liver biopsy, in the follow-up of liver diseases, and plays an adjunctive role with other liver tests.