Prognosis of 732 ursodeoxycholic acid‐treated patients with primary biliary cholangitis: A single center follow‐up study from China

Abstract

Background and Aim The impact of male sex and past hepatitis B virus (HBV) infection on survival of primary biliary cholangitis (PBC) are issues at discussion. The aim of the present study was to identify risk factors for transplant‐free survival (TRS) in Chinese PBC patients who received ursodeoxycholic acid (UDCA), with special focus on the impact of male sex and past HBV infection. Methods We followed up PBC patients who received UDCA at our institute between January 2000 and December 2017 until their death, liver transplantation, or censored on April 1, 2018, by interview and review of medical records. We used Cox proportional hazards model and Kaplan–Meier method. Results Out of 976 PBC patients, 732 UDCA‐treated patients (female : male = 6.2:1) with required clinical and laboratory data were enrolled in this study. The median follow‐up period were 4.8 years (interquartile range: 2.8–7.1 years). The overall 5‐, 10‐, and 15‐year TRS rates were 86.7% (95% CI: 83.8–88.1), 71.1% (95% CI: 65.0–77.2), and 59.2% (95% CI: 44.5–73.9), respectively. The survival was significantly worse for male patients and older patients (≥ 55 years) (log‐rank test: P < 0.05 for both). On multivariate analysis, male sex, cirrhosis, serum bilirubin, and serum albumin were independent predictors for TRS. There was no significant difference in survivals between patients with (n = 167) and without (n = 219) past HBV infection (log‐rank test: P = 0.293). Conclusions In this large Chinese cohort of UDCA‐treated PBC patients, male sex was associated with shorter survival, whereas past HBV infection was not associated with poorer outcome.

Clinical significance of IgG antimitochondrial M2 antibody levels in primary biliary cholangitis: A single center study from China

“…Among the 203 patients without complications who completed follow-up, 47.8% had cirrhosis at baseline, and the median follow-up time was 52 months (interquartile range: 28-75 months). The 5-year and 10-year TRS rates were 84.1% and 67.6%, respectively, which were consistent with the results of two other studies in China [19,20] but lower than those reported by the UK-PBC group [21]. By the end of follow-up, 121 patients (59.6%) had developed liver decompensation.…”

“…The reasons for the higher complication rates and lower survival rates in our cohort may be as follows: 1) the current cohort included a significant proportion of patients with advanced liver disease. The proportion of patients with compensated and decompensated cirrhosis was higher than that in a study conducted in Beijing [19] and that in a large cohort study conducted in Europe [22]. This may be because people in mainland China, especially those in less developed areas such as the northeast, do not have a high level of awareness of this disease.…”

Predictive Model of Ursodeoxycholic Acid Treatment Response in Primary Biliary Cholangitis

“…9,25,26 The elevation of total bilirubin level associated with the adverse outcome of PBC patients has been confirmed by many other surveys. [9][10][11][27][28][29][30] The elevation of total bilirubin might reflect progression of PBC. 9 Therefore, there is no doubt that bilirubin is one of the risk factors of early biochemical nonresponse.…”

A nomogram based on pretreatment clinical parameters for the prediction of inadequate biochemical response in primary biliary cholangitis

“…ALB, albumin; LLN, lower limit of normal; TBiL, total bilirubin; ULN; upper limit of normal study showed that men were more likely to have a shorter survival time than women in PBC patients treated with UDCA. 14 23 and Rotterdam criteria 9 ) but also an important predictor of the GLOBE score 6 and UK-PBC risk score. 10 Furthermore, Corpechot et al 5 reported that baseline TBiL levels were higher in patients with refractory disease.…”

“…Nevertheless, different biochemical response criteria were used to evaluate therapeutic efficacy in these studies. 6,[12][13][14] There are significant differences in the criteria for evaluating the UDCA response in PBC patients. 15 Given the potential risk of misidentification, the comprehensive evaluation of biochemical response can be superior to the use of a single criterion and could be helpful in risk stratification.…”