Predictors of liver failure in primary biliary cirrhosis

Abstract

Background. The disease progression of patients with primary biliary cirrhosis (PBC) varies significantly, and the prognostic markers that identify those patients who will develop liver failure have been scarcely studied from a Chinese cohort.

Aims. We aimed to determine the predictive factors of liver failure in patients with PBC.

Methods. Patients who were first diagnosed as PBC with hepatic compensation between January 2007 and December 2009 were enrolled in this cohort study.

Results. Altogether 398 patients were finally included. Of these patients, 80% were women, 98% had positive antimitochondrial antibodies, and 45% had positive antinuclear antibodies (ANA). To December 2012, a total of 38 patients developed liver failure. According to the outcome, patients who developed liver failure had had higher serum concentration of baseline total bilirubin (TBil) (p = 0.013) and total bile acid (TBA) (p < 0.001), and lower concentrations of baseline total cholesterol (Tch) (p = 0.008), than patients who did not develop liver failure. Additionally, the proportion of ANA positivity was statistically different between the two groups (p = 0.009). In the established model for predicting liver failure in PBC, three variables were finally selected out, including Tch (odds ratio (OR) 0.552, 95% confidence interval (CI) 0.394–0.774, p < 0.001), TBA (OR 1.006, 95% CI 1.002–1.010, p = 0.002), and ANA (+ versus –, OR 5.518, 95% CI 1.155–26.376, p = 0.032).

Conclusions. ANA, Tch, and TBA are predictors of liver failure in PBC.

Key words:

• Primary biliary cirrhosis
• liver failure
• predictor

Acknowledgements

We are grateful to Professor Yu-kun Han and Dr Xin-ying Liu for their great help in the patient enrollment. Zhen-man Wei was the guarantor; Pan Zhao designed the study; Wei-wei Liu, Jin-feng Li, and Pan Zhao analyzed the data; Hao-zhen Yang and Pan Zhao enrolled the patients; Pan Zhao, Hao Wang, Jun Xu, Rui-fang Wang, and Cheng Jin collected the data; Pan Zhao and Chun-ya Wang wrote the manuscript. All authors read and approved the final manuscript.

Pan Zhao, Wei-wei Liu, Jin-feng Li and Chun-ya Wang contributed equally to this work.

Declaration of interest: This work was partly supported by the 302 Hospital Research Project (YNKT2013009). The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.