title: Short-term prognostic factors for primary sclerosing cholangitis.
abstract: BACKGROUND
  It was recently reported that alkaline phosphatase (ALP) levels below 1.5 upper limit of normal (ULN) predicted better prognosis in primary sclerosing cholangitis (PSC). We evaluated whether ALP as well as other laboratory values were useful for the short-term prognosis of PSC in a Japanese cohort.
  
  
  METHODS
  In 78 patients with PSC (41 males and 37 females, mean onset age 41.9 years), the relationship between nine parameters (albumin, bilirubin, international normalized ratio of prothrombin time [PT-INR], ALP, aspartate aminotransferase [AST], alanine aminotransferase [ALT], γ-glutamyl transpeptidase [γ-GTP], platelet, and calculated Model for End-Stage Liver Disease [MELD] score), and liver related clinical endpoints (death due to liver failure, variceal bleeding, liver transplantation, and biliary carcinoma) were retrospectively examined. Using receiver operating characteristic (ROC) analysis, we investigated which parameter was useful for predicting the short-term prognosis.
  
  
  RESULTS
  Average follow-up period was 8.6 years. The endpoints were evaluated in 40 patients. Seven patients died of liver failure, three patients developed variceal bleeding, nine patients received liver transplantation from a living donor, 13 patients received certified brain-dead liver transplantation, and eight patients developed biliary carcinoma. The parameters with an area under the curve (AUC) of more than 0.8 were albumin, bilirubin, PT-INR, ALP, and MELD score. AUC for ALP was 0.85. The optimal cutoff value was 2.3 ULN. Despite the use or non-use of ursodeoxycholic acid, short-term prognosis of patients with an ALP level below 2.3 ULN was good.
  
  
  CONCLUSIONS
  We confirmed that keeping ALP low is associated with better short-term prognosis in a Japanese cohort. In addition, Alb, Bil, PT-INR, and MELD score were good predictors.
authors.affiliation: Department of Gastroenterology, Kanto Central Hospital of the Mutual Aid Association of Public School Teachers, 6-25-1 Kamiyouga, Setagaya-ku, Tokyo, 158-8531, Japan. takeowata@gmail.ac.jp.|Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. takeowata@gmail.ac.jp.
authors.forename: Takeo
authors.initials: T
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|Department of Gastroenterology, Tokyo Takanawa Hospital, Tokyo, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirano
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tada
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Isayama
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.|Department of Gastroenterology, Toshiba General Hospital, Tokyo, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Mizuno
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Arizumi
authors.affiliation: Department of Gastroenterology, Mitsui Memorial Hospital, Tokyo, Japan.
authors.forename: Nobuo
authors.initials: N
authors.lastname: Toda
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Sugawara
authors.affiliation: Artificial Organ and Transplantation Division, Department of Surgery, The University of Tokyo, Tokyo, Japan.
authors.forename: Norihiro
authors.initials: N
authors.lastname: Kokudo
authors.affiliation: Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Koike
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002648:Child; D015209:Cholangitis, Sclerosing / Q000150:complications* / Q000201:enzymology; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000201:enzymology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult
chemical_list: D015415:Biomarkers; D000469:Alkaline Phosphatase
keywords: Alkaline phosphatase; MELD score; Primary sclerosing cholangitis; Prognosis; Ursodeoxycholic acid