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

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), pp. 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

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Date deposited: 13 Jan 2010
Last modified: 19 Jul 2017 00:04

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Contributors

Author: Marlyn J. Mayo
Author: Julie Parkes
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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