Prognostic Factors in Primary Biliary Cholangitis: A Retrospective Study of Joint Slovak and Croatian Cohort of 249 Patients

Jakub Gazda; Sylvia Drazilova; Martin Janicko; Ivica Grgurevic; Tajana Filipec Kanizaj; Tomas Koller; Beatrica Bodorovska; Tonci Bozin; Maja Mijic; Zrinka Rob; Ivana Mikolasevic; Anita Madir; Branislav Kucinsky; Peter Jarcuska

doi:10.3390/jpm11060495

Prognostic Factors in Primary Biliary Cholangitis: A Retrospective Study of Joint Slovak and Croatian Cohort of 249 Patients

J Pers Med. 2021 Jun 1;11(6):495. doi: 10.3390/jpm11060495.

Authors

Jakub Gazda¹, Sylvia Drazilova^{1

2}, Martin Janicko¹, Ivica Grgurevic^{3

4}, Tajana Filipec Kanizaj^{4

5}, Tomas Koller⁶, Beatrica Bodorovska⁷, Tonci Bozin³, Maja Mijic⁵, Zrinka Rob³, Ivana Mikolasevic^{5

8}, Anita Madir⁴, Branislav Kucinsky¹, Peter Jarcuska¹

Affiliations

¹ 2nd Department of Internal Medicine, PJ Safarik University in Kosice and L. Pasteur University Hospital, Trieda SNP 1, 040 11 Kosice, Slovakia.
² Internal Medicine Department, Hospital Poprad, a.s., 058 01 Poprad, Slovakia.
³ Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Avenija Gojka Suska 6, 10000 Zagreb, Croatia.
⁴ Department of Gastroenterology, Hepatology and Clinical Nutrition, School of Medicine, University of Zagreb, Salata ul. 2, 10000 Zagreb, Croatia.
⁵ Department of Gastroenterology, University Hospital Merkur, Zajceva ul. 19, 10000 Zagreb, Croatia.
⁶ 5th Department of Internal Medicine, Subdivision of Gastroenterology and Hepatology, Comenius University Faculty of Medicine, University Hospital Bratislava, Ruzinovska 6, 826 06 Bratislava, Slovakia.
⁷ Clinic of Gastroenterological Internal Medicine, Comenius University in Bratislava and University Hospital Martin, Kollarova 2, 036 59 Martin, Slovakia.
⁸ Department of Gastroenterology, School of Medicine, University of Rijeka, Brace Branchetta 20/1, 51000 Rijeka, Croatia.

Abstract

Objective: To identify pretreatment laboratory parameters associated with treatment response and to describe the relationship between treatment response and liver decompensation in patients with primary biliary cholangitis treated with ursodeoxycholic acid.

Methods: We defined treatment response as both ALP ≤ 1.67 × ULN and total bilirubin ≤ 2 × ULN. Multiple logistic regression analyses were performed to adjust for confounding effects of sociodemographic variables.

Results: Pretreatment total bilirubin ((TB); OR = 0.3388, 95%CI = 0.1671-0.6077), ALT (OR = 0.5306, 95%CI = 0.3830-0.7080), AST (OR = 0.4065, 95%CI = 0.2690-0.5834), ALP (OR = 0.3440, 95%CI = 0.2356-0.4723), total cholesterol ((TC); OR = 0.7730, 95%CI = 0.6242-0.9271), APRI (OR = 0.3375, 95%CI = 0.1833-0.5774), as well as pretreatment albumin (OR = 1.1612, 95%CI = 1.0706-1.2688) and ALT/ALP (OR = 2.4596, 95%CI = 1.2095-5.5472) were associated with treatment response after six months of treatment. Pretreatment TB (OR = 0.2777, 95%CI = 0.1288-0.5228), ALT (OR = 0.5968, 95%CI = 0.4354-0.7963), AST (OR = 0.4161, 95%CI = 0.2736-0.6076), ALP (OR = 0.4676, 95%CI = 0.3487-0.6048), APRI (OR = 0.2838, 95%CI = 0.1433-0.5141), as well as pretreatment albumin (OR = 1.2359, 95%CI = 1.1257-1.3714) and platelet count (OR = 1.0056, 95%CI = 1.0011-1.0103) were associated with treatment response after 12 months of treatment. Treatment response after 6 months of UDCA therapy is significantly associated with treatment response after 12 months of UDCA therapy (OR = 25.2976, 95% CI = 10.5881-68.4917). Treatment responses after 6 and 12 months of UDCA therapy decrease the risk of an episode of liver decompensation in PBC patients (OR = 12.1156, 95%CI = 3.7192-54.4826 and OR = 21.6000, 95%CI = 6.6319-97.3840, respectively).

Conclusions: There are several pretreatment laboratory parameters associated with treatment response in patients with primary biliary cholangitis. Treatment response after six months is significantly associated with treatment response after 12 months of ursodeoxycholic acid (UDCA) therapy. Treatment responses after 6 and 12 months of UDCA decrease the risk of an episode of liver decompensation.

Keywords: liver decompensation; primary biliary cholangitis; prognostic factors; treatment response; ursodeoxycholic acid.