title: Primary biliary cirrhosis in Singapore: evaluation of demography, prognostic factors and natural course in a multi-ethnic population.
abstract: OBJECTIVE
  Primary biliary cirrhosis (PBC) is infrequent in Asians. Among Asian patients with PBC, information on natural course is scarce. The aim of this study was to study the clinical course and prognosticators among Asians with PBC.
  
  
  METHODS
  During 1990-2005, patients diagnosed with PBC at the National University Hospital, Singapore, constituted the retrospective cohort. Their demographic characteristics were evaluated. To evaluate the prognostic factors and natural course, two outcome measures were assessed: hepatic decompensation and death or liver transplant. Multivariate analysis was undertaken to identify factors associated with hepatic decompensation and terminal event (death or liver transplantation).
  
  
  RESULTS
  Thirty-four PBC patients aged 56.8 +/- 1.8 years (mean +/- SEM) of whom 32 (94%) were women were included. Thirty-two (94%) of them were of Chinese origin. At presentation, 18 (53%) were symptomatic in the form of jaundice (n = 9, 26.5%), pruritus (n = 6, 17.6%) and fatigue (n = 5, 14.7%). During 4.80 +/- 0.7 (range 0.02-15.03) years follow up, 6/16 (37.5%) asymptomatic patients developed symptoms. After 5 years, 17.6% (n = 6) and 8.8% (n = 3) had hepatic decompensation and terminal event, respectively. Sicca syndrome was present in 26% (n = 9) of patients. Multivariate analysis revealed that serum bilirubin level at presentation was the sole determinant of decompensation. Rate of change of laboratory indices did not predict either event.
  
  
  CONCLUSIONS
  In Singapore, Chinese women constitute most of the PBC patients. Elevated serum bilirubin level at presentation was the sole predictive marker associated with dismal outcome.
authors.affiliation: Department of Gastroenterology and Hepatology, National University Hospital, Singapore.
authors.forename: Reuben-Km
authors.initials: RK
authors.lastname: Wong
authors.forename: Seng-Gee
authors.initials: SG
authors.lastname: Lim
authors.forename: Aileen
authors.initials: A
authors.lastname: Wee
authors.forename: Yiong-Huak
authors.initials: YH
authors.lastname: Chan
authors.forename: Myat-Oo
authors.initials: MO
authors.lastname: Aung
authors.forename: Chun-Tao
authors.initials: CT
authors.lastname: Wai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008105:Liver Cirrhosis, Biliary / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D012846:Singapore / Q000453:epidemiology