Underestimated Male Prevalence of Primary Biliary Cholangitis in China: Results of a 16-yr cohort study involving 769 patients

Fan, Xiaoli; Wang, Tingting; Shen, Yi; Xi, Xiaotan; Yang, Li

doi:10.1038/s41598-017-06807-7

Cited by 21 publications

(21 citation statements)

References 39 publications

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“…A significant female preponderance is a well‐known clinical feature of PBC, and the F:M ratio has been reported as approximately 10:1 . However, the F:M ratio (6.2:1) in our cohort was much lower than previously reported, but consistent with a recently published Chinese cohort (6.1:1) and a previous study of our own (6.9:1). This is also in line with two population‐based large cohorts from northern Italy and Denmark, which showed F:M ratios of 2.3:1 and 4.2:1, respectively, indicating there might be an underestimated prevalence of PBC in men .…”

Section: Discussionsupporting

confidence: 92%

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

Chen

Duan

et al. 2018

J of Gastro and Hepatol

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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.

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Section: Discussionsupporting

confidence: 92%

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

Chen

Duan

et al. 2018

J of Gastro and Hepatol

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“…The female-to-male ratio of 5.82:1 in the current study was less than 9–10:1, a ratio classically reported for PBC 5,38,39 . However, several population-based studies suggest an increasing male prevalence for PBC 8,40–44 , and the opposite trend was observed for the sample size and female-to-male ratio 44 . Thus, the percentage of males with PBC in most studies might be underestimated and highlights the importance of surveying the gender impact on the prognosis of PBC.…”

Section: Discussionmentioning

confidence: 92%

“…In addition to hepatic manifestations such as liver cirrhosis and hepatocellular carcinoma (HCC) 3 , PBC can lead to multiple extrahepatic manifestations, including extrahepatic malignancies (EMs) 7 , autoimmune diseases 8 , dyslipidemia, and other metabolic diseases 9 . The prevalence of EM in PBC patients ranged from 4.5% 10 to 15.7% 11 .…”

Section: Introductionmentioning

confidence: 99%

“…Consistently, up to 1/3 of PBC patients have a concomitant extrahepatic autoimmune disease 15 . Common extrahepatic autoimmune conditions include Sjögren syndrome (SS), autoimmune thyroid diseases, and systemic lupus erythematosus (SLE) 8 . Although extrahepatic autoimmune diseases might be associated with EM development in PBC 7 , whether extrahepatic autoimmune diseases affect the prognosis of PBC patients remains conflicting 15,16 .…”

Section: Introductionmentioning

confidence: 99%

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The extrahepatic events of Asian patients with primary biliary cholangitis: A 30-year cohort study

Lin

Cheng

Chang

et al. 2019

Sci Rep

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The extrahepatic complications of primary biliary cholangitis (PBC) in Asian patients remain elusive. A 30-year cohort study of 150 Taiwanese PBC patients treated with ursodeoxycholic acid (UDCA) was conducted. Patients with alkaline phosphatase levels >1.67 × ULN after 1-year treatment were considered suboptimal responders. At baseline, of 150 patients (mean age: 53.75 years), 128 (85.3%) were females, and 34 (22.8%) had cirrhosis. The cumulative incidences of various incident events were all-cause mortality or liver transplantation: 46.7%; extrahepatic mortality: 24.5%; extrahepatic malignancies: 8.1%; hypertension: 46.2%; dyslipidemia: 44.1%; diabetes: 30.6%; hyperuricemia: 11.2%; acute coronary syndrome: 3.1%; cerebral vascular accident (CVA): 8.9%; autoimmune diseases: 16%; and osteoporosis: 20.9%. The 5- to 20-year cumulative incidences for all-cause mortality or liver transplantation and extrahepatic mortality were 16.2–41.3% and 3.1–11.9%, respectively. Baseline associations were age and alpha-fetoprotein levels with extrahepatic mortality, 80% due to sepsis; age with extrahepatic malignancies and hypertension; gender and hyperuricemia with CVA; and UDCA response with autoimmune disease. Conclusions: Sepsis accounted for most extrahepatic mortality in PBC patients, and the longer the follow-up was, the higher the extrahepatic/all-cause mortality ratio. Baseline age is crucial for incident extrahepatic events and only CVA shows gender-dimorphism; the association between UDCA response and autoimmune disease requires further investigation.

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“…A total of 573 studies were retrieved. According to the aforementioned screening criteria and double assessment by two reviewers, we excluded 151 duplicate documents by reading topics and abstracts, removed 330 documents that did not meet the inclusion criteria, ruled out 46 non-conforming documents by reading the full text, and finally incorporated 46 articles, [15,[17][18][19][21][22][23][24]27,28,32,35,44,50,57], including 10 in English and five in Chinese. In addition, 14 papers did not describe the type of study and could not be judged [13,16,25,31,33,34,[37][38][39][40][41]43,48,58], and there was only one ambispective cohort study [49].…”

Section: Search Resultsmentioning

confidence: 99%

Methodological quality of cohort study on rheumatic diseases in China: A systematic review

Zhang

Dai

et al. 2020

PLoS ONE

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To evaluate systematically the quality of the cohort studies on rheumatic diseases in China. Methods Relevant databases were searched to find cohort studies on rheumatic diseases in China, and the basic information included in the literature was extracted and analyzed. Chinese and English literature were then compared with regard to methodological quality, according to the Newcastle-Ottawa Scale (NOS). Results In total, we included 46 cohort studies, with 19 studies published in English and 27 studies published in Chinese. With regard to the basic characteristics of the literature, 78.26% of the studies were published in the past four years; 16 studies were associated with hyperuricemia, followed by eight studies involving systemic lupus erythematosus. The sample size of the studies in Chinese was lower than that in English studies (P< 0.05). The English literature was superior to the Chinese literature in terms of informed consent, ethical review and selection of statistical analysis methods. The methodology quality of the 46 included studies showed that the English and Chinese NOS scores were 5.59 ± 1.25 and 6.06 ± 1.11, respectively, and the difference was significant (P< 0.01). The "representativeness of the exposed group", "demonstration that outcome of interest was not present at start of study", and the "adequacy of follow up of cohorts" scores were relatively low in Chinese and English studies. The score for "was follow-up long enough for outcomes to occur" item in English was higher than that in the Chinese studies; however, the "study controls for the most important factor" score for Chinese papers was better than that for the English papers.

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Underestimated Male Prevalence of Primary Biliary Cholangitis in China: Results of a 16-yr cohort study involving 769 patients

Cited by 21 publications

References 39 publications

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

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

The extrahepatic events of Asian patients with primary biliary cholangitis: A 30-year cohort study

Methodological quality of cohort study on rheumatic diseases in China: A systematic review

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