Fibrosis stage is an independent predictor of outcome in primary biliary cholangitis despite biochemical treatment response

被引：81

作者：

Perez, Carla F. Murillo ^{[1
,2
]}

Hirschfield, Gideon M. ^{[1
]}

Corpechot, Christophe ^{[4
]}

Floreani, Annarosa ^{[5
]}

Mayo, Marlyn J. ^{[6
]}

van der Meer, Adriaan ^{[2
]}

Ponsioen, Cyriel Y. ^{[7
]}

Lammers, Willem J. ^{[2
]}

Pares, Albert ^{[8
]}

Invernizzi, Pietro ^{[9
,10
]}

Carbone, Marco ^{[9
,10
]}

Battezzati, Pier Maria ^{[11
]}

Nevens, Frederik ^{[12
]}

Kowdley, Kris V. ^{[13
]}

Thorburn, Douglas ^{[14
]}

Mason, Andrew L. ^{[15
]}

Trivedi, Palak J. ^{[16
,17
]}

Lindor, Keith D. ^{[18
]}

Bruns, Tony ^{[19
,20
]}

Dalekos, George N. ^{[21
,22
]}

Gatselis, Nikolaos K. ^{[21
,22
]}

Verhelst, Xavier ^{[23
]}

Janssen, Harry L. A. ^{[1
]}

Hansen, Bettina E. ^{[1
,3
]}

Gulamhusein, Aliya ^{[1
,3
]}

机构：

[1] Univ Hlth Network, Toronto Gen Hosp, Toronto Ctr Liver Dis, Toronto, ON, Canada

[2] Erasmus Univ, Med Ctr, Gastroenterol & Hepatol, Rotterdam, Netherlands

[3] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

[4] Hop St Antoine, Ctr Reference Malad Inflammatoires Voies Biliaire, Paris, France

[5] Univ Padua, Dept Surg Oncol & Gastroenterol, Padua, Italy

[6] UT Southwestern Med Ctr Dallas, Digest & Liver Dis, Dallas, TX USA

[7] Acad Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[8] Univ Barcelona, IDIBAPS, CIBERehd, Liver Unit,Hosp Clin, Barcelona, Spain

[9] Univ Milano Bicocca, San Gerardo Hosp, Div Gastroenterol, Milan, Italy

[10] Univ Milano Bicocca, San Gerardo Hosp, Ctr Autoimmune Liver Dis, Milan, Italy

[11] Univ Milan, Dept Hlth Sci, Milan, Italy

[12] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Hepatol, Leuven, Belgium

[13] Swedish Med Ctr, Liver Care Network, Seattle, WA USA

[14] Royal Free Hosp, Sheila Sherlock Liver Ctr, London, England

[15] Univ Alberta, Div Gastroenterol & Hepatol, Edmonton, AB, Canada

[16] Univ Birmingham, Natl Inst Hlth Res, Birmingham Biomed Res Ctr, Birmingham, W Midlands, England

[17] Univ Birmingham, Ctr Liver Res, Birmingham, W Midlands, England

[18] Arizona State Univ, Phoenix, AZ USA

[19] Friedrich Schiller Univ, Jena Univ Hosp, Dept Internal Med 4, Jena, Germany

[20] Univ Hosp RWTH Aachen, Dept Med 3, Aachen, Germany

[21] Univ Thessaly, Dept Med, Larisa, Greece

[22] Univ Thessaly, Res Lab Internal Med, Larisa, Greece

[23] Ghent Univ Hosp, Dept Gastroenterol & Hepatol, Ghent, Belgium

来源：

ALIMENTARY PHARMACOLOGY & THERAPEUTICS | 2019年 / 50卷 / 10期

关键词：

PLACEBO-CONTROLLED TRIAL; URSODEOXYCHOLIC ACID; LIVER FIBROSIS; ASPARTATE-AMINOTRANSFERASE; NONINVASIVE ASSESSMENT; LARGE COHORT; FOLLOW-UP; CIRRHOSIS; PROGRESSION; PROGNOSIS;

D O I：

10.1111/apt.15533

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background Fibrosis stage predicts prognosis in patients with chronic liver disease independent of aetiology, although its precise role in risk stratification in patients with primary biliary cholangitis (PBC) remains undefined. Aims To assess the utility of baseline fibrosis stage in predicting long-term outcomes in the context of biochemical risk stratification Methods In a large and globally representative cohort of patients with PBC, liver biopsies performed from 1980 to 2014 were evaluated. The predictive ability of histologic fibrosis stage in addition to treatment response at 1 year (Toronto/Paris-II criteria), as well as non-invasive markers of fibrosis (AST/ALT ratio [AAR], AST to platelet ratio index [APRI], FIB-4), for transplant-free survival was assessed with Cox proportional-hazards models. Results There were 1828 patients with baseline liver biopsy. Advanced histologic fibrosis (stage 3/4) was an independent predictor of survival in addition to non-invasive measures of fibrosis with the hazard ratios ranging from 1.59 to 2.73 (P < .001). Patients with advanced histologic fibrosis stage had worse survival despite biochemical treatment response, with a 10-year survival of 76.0%-86.6% compared to 94.5%-95.1% depending on the treatment response criteria used. Poor correlations were observed between non-invasive measures of fibrosis and histologic fibrosis stage. Conclusion Assessment of fibrosis stage grants prognostic value beyond biochemical treatment response at 1 year. This highlights the need to incorporate fibrosis stage in individual risk stratification in patients with PBC, partly to identify those that may derive benefit from novel therapies.

引用

页码：1127 / 1136

页数：10

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