Prevalence and prognostic significance of main metabolic risk factors in primary biliary cholangitis: a retrospective cohort study of 789 patients

Abstract

BackgroundMetabolic risk factors in primary biliary cholangitis (PBC) have not been well described in China. Additionally, it is unclear whether these factors have an impact on the prognosis of PBC patients. Therefore, this study aimed to investigate the prevalence of main metabolic risk factors in PBC, and to evaluate their prognostic values for liver-related outcomes.MethodsA cohort of 789 PBC patients was retrospectively studied between July 2008 and September 2019 by investigating the main metabolic risk factors and analyzing liver-related outcomes.ResultsAt presentation, 271 (34.3%) patients had concomitant hyperlipidemia, 126 (16.0%) had hypertension, 94 (11.9%) had type 2 diabetes mellitus (T2DM), and 17 (2.2%) had nonalcoholic fatty liver disease (NAFLD). Hyperlipidemia was found to be associated with the lower risk of liver-related death [P<0.0001, hazard ratio (HR): 0.397, 95% confidence interval (CI): 0.268–0.588] and adverse outcomes (P<0.0001, HR: 0.487, 95% CI:0.367–0.646), while hypertension was noted as a risk factor for liver-related death (P=0.001, HR: 1.788, 95% CI:1.268–2.521) and adverse outcomes (P=0.014, HR: 1.417, 95% CI:1.074–1.869). Moreover, age ≥ 55 years old (P=0.005) and cirrhosis (P<0.0001) had superimposition effects on hypertension as a risk factor for liver-related death, while only cirrhosis (P<0.0001) had an effect on hypertension as a risk factor for adverse outcomes. Additionally, anti-sp100 was associated with adverse outcomes (P=0.013) in PBC patients with hypertension in univariate Cox regression analysis.ConclusionHyperlipidemia, hypertension, and T2DM were found as main metabolic risk factors in PBC in China. Hyperlipidemia indicated a benign clinical outcome of PBC, while hypertension indicated a poor outcome of PBC. Older age and cirrhosis had superimposition effects on hypertension for liver-related poor outcomes. Anti-sp100 might be associated with adverse outcomes, especially in PBC patients with hypertension.

Dyslipidemia, Cholangitis and Fatty Liver Disease: The Close Underexplored Relationship: A Narrative Review

“…Among the other illnesses potentially heightening the overall cardiovascular risk factors in PBC subjects, we can find hypertension and T2DM (besides dyslipidemia, as already indicated in the paragraph above), with hypertension playing an apparently significant role in worsening these patients' outcomes; in particular, anti-sp100 antibodies considered specific for PBC were found associated with adverse outcomes in PBC subjects [77].…”

“…There are many commonalities between MASLD and acute cholangitis: the latter is also associated with T2DM and insulin resistance [75], obesity (which is, in turn, strongly predisposes individuals to the formation of gallstones) [76], and intestinal dysbiosis (understood as an imbalance of intestinal bacterial flora) [77]. The most likely hypothesis is that primary bacteremia of the presumed gastrointestinal origin in MAFLD patients, supporting the role of the gut-liver axis [78], can be associated with the low-grade inflammation generated chronically in the liver condition (MASLD) and may somehow predispose individuals to inflammation in the small-and medium-sized bile ducts.…”

Association between diabetes mellitus and primary biliary cholangitis: a two-sample Mendelian randomization study

“…Diabetes has a long history of causing liver damage. In a retrospective cohort study in China, T2DM was found to be one of the major metabolic risk factors for PBC, with 11.9% of patients with T2DM having lower albumin, platelet counts and a higher rate of cirrhosis than non-T2DM patients; however, 54.3% of these patients also had hyperlipidemia, hypertension and NAFLD ( 9 ), which caused some interference in the study. In the most recent years, several epidemiologic studies have demonstrated a strong correlation between DM and autoimmune liver disease.…”