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.


CONCLUSIONS
The ELF algorithm is a highly accurate noninvasive measure of PBC disease severity that provides useful long-term prognostic information.
University of Texas Southwestern Medical Center, Dallas, TX 75390-9151, USA. marlyn.mayo@utsouthwestern.edu
Marlyn J
MJ
Mayo
Julie
J
Parkes
Beverley
B
Adams-Huet
Burton
B
Combes
A S
AS
Mills
Rodney S
RS
Markin
Raphael
R
Rubin
Donald
D
Wheeler
Melissa
M
Contos
A B
AB
West
Sandra
S
Saldana
Yonas
Y
Getachew
Robert
R
Butsch
Velimir
V
Luketic
Marion
M
Peters
Adrian
A
Di Bisceglie
Nathan
N
Bass
John
J
Lake
Thomas
T
Boyer
Enrique
E
Martinez
James
J
Boyer
Guadalupe
G
Garcia-Tsao
David
D
Barnes
William M
WM
Rosenberg
D000328:Adult; D000465:Algorithms; D001663:Bilirubin / Q000097:blood; D001706:Biopsy; D018450:Disease Progression; D005355:Fibrosis; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008105:Liver Cirrhosis, Biliary / Q000188:drug therapy / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011379:Prognosis; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D001663:Bilirubin; D008727:Methotrexate