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Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay

Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay
Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay
Primary biliary cirrhosis (PBC) is sometimes diagnosed based on a positive antimitochondrial antibody in the appropriate clinical setting without a liver biopsy. Although a liver biopsy can assess the extent of liver fibrosis and provide prognostic information, serum fibrosis markers avoid biopsy complications and sampling error and provide results as a continuous variable, which may be more precise than categorical histological stages. The current study was undertaken to evaluate serum fibrosis markers as predictors of clinical progression in a large cohort of PBC patients. Serial liver biopsy specimens and serum samples were collected every 2 years in 161 PBC subjects for a median of 7.3 years. Clinical progression was defined as development of one or more of the following events: varices, variceal bleed, ascites, encephalopathy, liver transplantation, or liver-related death. Serum hyaluronic acid, tissue inhibitor of metalloproteinase 1, and procollagen III aminopeptide were measured and entered into the previously validated enhanced liver fibrosis (ELF) algorithm. The ability of ELF, histological fibrosis, bilirubin, Model for End-Stage Liver Disease (MELD), and Mayo Risk Score to differentiate between individuals who would experience a clinical event from those who would not was evaluated at different time points. Event-free survival was significantly lower in those with high baseline ELF. Each 1-point increase in ELF was associated with a threefold increase in future complications. The prognostic performance of all tests was similar when performed close to the time of the first event. However, at earlier times in the disease process (4 and 6 years before the first event), the prognostic performance of ELF was significantly better than MELD or Mayo R score. Conclusion: The ELF algorithm is a highly accurate noninvasive measure of PBC disease severity that provides useful long-term prognostic information. (HEPATOLOGY 2008;48:1549-1557.)
prediction, biochemical markers, hyaluronic acid, fibrotest, virus, liver, biomarkers, cohort, biopsy, england, time, fibrosis, abilities, bilirubin, serum, patients, randomized-trial, complications, outcomes, chronic hepatitis-c, model, risk, acid, disease, antibodies, death, survival, liver transplantation, transplantation, outcome, severity, sampling variability, noninvasive markers
0270-9139
1549-1557
Mayo, Marlyn J.
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Parkes, Julie
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Adams-Huet, Beverley
43487194-efdf-4216-8307-72b22573788a
Combes, Burton
096ac2d4-e581-4de3-81e9-564f3aa5fe79
Mills, A. S.
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Markin, Rodney S.
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Rubin, Raphael
ecbc62c0-b12a-4137-bdef-849c6f00f6d5
Wheeler, Donald
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Contos, Melissa
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West, A. B.
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Saldana, Sandra
b2304ccb-59a7-4fe9-98a0-5c0b5cc4f0c1
Getachew, Yonas
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Butsch, Robert
d61889be-e242-494b-a299-204ffff5dd14
Luketic, Velimir
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Peters, Marion
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Di Bisceglie, Adrian
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Bass, Nathan
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Lake, John
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Boyer, Thomas
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Martinez, Enrique
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Boyer, James
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Garcia-Tsao, Guadalupe
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Barnes, David
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Rosenberg, William M.
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Mayo, Marlyn J.
566c2d2f-dd07-43ca-b9a3-4bd8636ffae7
Parkes, Julie
59dc6de3-4018-415e-bb99-13552f97e984
Adams-Huet, Beverley
43487194-efdf-4216-8307-72b22573788a
Combes, Burton
096ac2d4-e581-4de3-81e9-564f3aa5fe79
Mills, A. S.
a3df73b3-7d7f-4485-b36f-52a0307c3fe1
Markin, Rodney S.
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Rubin, Raphael
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Wheeler, Donald
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Contos, Melissa
50de35dc-e29a-462e-8008-ff064611ef04
West, A. B.
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Saldana, Sandra
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Getachew, Yonas
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Butsch, Robert
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Luketic, Velimir
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Peters, Marion
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Di Bisceglie, Adrian
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Bass, Nathan
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Lake, John
7adbb52a-2825-4881-abe1-3d018ab7a001
Boyer, Thomas
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Martinez, Enrique
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Boyer, James
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Garcia-Tsao, Guadalupe
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Barnes, David
fb271bcd-07db-481f-85dd-057e7c73033b
Rosenberg, William M.
ac36bd93-2303-4a46-96f6-3daee7ec53b5

Mayo, Marlyn J., Parkes, Julie, Adams-Huet, Beverley, Combes, Burton, Mills, A. S., Markin, Rodney S., Rubin, Raphael, Wheeler, Donald, Contos, Melissa, West, A. B., Saldana, Sandra, Getachew, Yonas, Butsch, Robert, Luketic, Velimir, Peters, Marion, Di Bisceglie, Adrian, Bass, Nathan, Lake, John, Boyer, Thomas, Martinez, Enrique, Boyer, James, Garcia-Tsao, Guadalupe, Barnes, David and Rosenberg, William M. (2008) Prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay. Hepatology, 48 (5), 1549-1557. (doi:10.1002/hep.22517). (PMID:18846542)

Record type: Article

Abstract

Primary biliary cirrhosis (PBC) is sometimes diagnosed based on a positive antimitochondrial antibody in the appropriate clinical setting without a liver biopsy. Although a liver biopsy can assess the extent of liver fibrosis and provide prognostic information, serum fibrosis markers avoid biopsy complications and sampling error and provide results as a continuous variable, which may be more precise than categorical histological stages. The current study was undertaken to evaluate serum fibrosis markers as predictors of clinical progression in a large cohort of PBC patients. Serial liver biopsy specimens and serum samples were collected every 2 years in 161 PBC subjects for a median of 7.3 years. Clinical progression was defined as development of one or more of the following events: varices, variceal bleed, ascites, encephalopathy, liver transplantation, or liver-related death. Serum hyaluronic acid, tissue inhibitor of metalloproteinase 1, and procollagen III aminopeptide were measured and entered into the previously validated enhanced liver fibrosis (ELF) algorithm. The ability of ELF, histological fibrosis, bilirubin, Model for End-Stage Liver Disease (MELD), and Mayo Risk Score to differentiate between individuals who would experience a clinical event from those who would not was evaluated at different time points. Event-free survival was significantly lower in those with high baseline ELF. Each 1-point increase in ELF was associated with a threefold increase in future complications. The prognostic performance of all tests was similar when performed close to the time of the first event. However, at earlier times in the disease process (4 and 6 years before the first event), the prognostic performance of ELF was significantly better than MELD or Mayo R score. Conclusion: The ELF algorithm is a highly accurate noninvasive measure of PBC disease severity that provides useful long-term prognostic information. (HEPATOLOGY 2008;48:1549-1557.)

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More information

Submitted date: February 2008
Published date: June 2008
Keywords: prediction, biochemical markers, hyaluronic acid, fibrotest, virus, liver, biomarkers, cohort, biopsy, england, time, fibrosis, abilities, bilirubin, serum, patients, randomized-trial, complications, outcomes, chronic hepatitis-c, model, risk, acid, disease, antibodies, death, survival, liver transplantation, transplantation, outcome, severity, sampling variability, noninvasive markers
Organisations: Community Clinical Sciences, Medicine

Identifiers

Local EPrints ID: 70039
URI: http://eprints.soton.ac.uk/id/eprint/70039
ISSN: 0270-9139
PURE UUID: c6360023-2576-4422-913b-cafa7060e5d0
ORCID for Julie Parkes: ORCID iD orcid.org/0000-0002-6490-395X

Catalogue record

Date deposited: 13 Jan 2010
Last modified: 14 Mar 2024 02:42

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Contributors

Author: Marlyn J. Mayo
Author: Julie Parkes ORCID iD
Author: Beverley Adams-Huet
Author: Burton Combes
Author: A. S. Mills
Author: Rodney S. Markin
Author: Raphael Rubin
Author: Donald Wheeler
Author: Melissa Contos
Author: A. B. West
Author: Sandra Saldana
Author: Yonas Getachew
Author: Robert Butsch
Author: Velimir Luketic
Author: Marion Peters
Author: Adrian Di Bisceglie
Author: Nathan Bass
Author: John Lake
Author: Thomas Boyer
Author: Enrique Martinez
Author: James Boyer
Author: Guadalupe Garcia-Tsao
Author: David Barnes
Author: William M. Rosenberg

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