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

A study in the latest issue of Hepatology examines the prediction of clinical outcomes in primary biliary cirrhosis by serum enhanced liver fibrosis assay.

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Primary biliary cirrhosis is sometimes diagnosed based on a positive antimitochondrial antibody in the appropriate clinical setting without a liver biopsy.

A liver biopsy can assess the extent of liver fibrosis and provide prognostic information.

However, 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.

Dr Marlyn Mayo from Texas evaluated serum fibrosis markers as predictors of clinical progression in a large cohort of primary biliary cirrhosis patients.

Event-free survival was lower in those with high baseline enhanced liver fibrosis
Hepatology

Serial liver biopsy specimens and serum samples were collected every 2 years in 161 primary biliary cirrhosis subjects for a median of 7 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 algorithm.

The team evaluated at different time points the ability of enhanced liver fibrosis, 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.

Event-free survival was significantly lower in those with high baseline enhanced liver fibrosis.

Each 1-point increase in enhanced liver fibrosis was associated with a 3-fold increase in future complications.

The research team observed that 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, the prognostic performance of enhanced liver fibrosis was significantly better than MELD or Mayo R score.

Dr Mayo‘s team concludes, “The enhanced liver fibrosis algorithm is a highly accurate noninvasive measure of primary biliary cirrhosis disease severity that provides useful long-term prognostic information."

Hepatol 2008: 48(5): 1549-57


31 October 2008

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