Prognostic value of noninvasive fibrosis scores in primary biliary cholangitis

Abstract

Objective: To explore the prognostic value of several widely used noninvasive fibrosis scores (NIFS) for the mortality due to liver-related events in Chinese primary biliary cholangitis (PBC) population. Study Design: An observational study. Place and Duration of Study: Department of Infectious Diseases and Hepatology, the Second Hospital of Shandong University, Jinan, China, from August 2008 to July 2018. Methodology: Patients were diagnosed as PBC when they fulfilled at least two of the following criteria: presence of anti-mitochondrial antibodies (AMA), or other PBC-specific autoantibodies; and/or biochemical evidence of cholestasis; and/or histological evidence of liver biopsy. Patients were excluded if they were just started UDCA administration within last year, followed up for less than a year, diagnosed as overlap syndrome, or suffered from other coexisting hepatic diseases. Clinical data were recorded and scores of 11 generally accepted NIFS were calculated. Cox proportional hazards model was performed to explore independent predictors of liver-related mortality. Results: Sixty-five PBC patients were included in the current cohort. Five patients died due to liver-related events during a median of 35-month follow-up. The 5-year cumulative survival rate was 88.4%. Non-survival patients were characterised with lower platelet count (p=0.049), lower level of albumin (p=0.018), higher fibrosis index (p<0.001) and higher Doha score (p=0.006). Multivariate Cox regression analysis identified fibrosis index (HR 17.449, 95% CI 1.410-215.989, p=0.026) and Doha score (HR 1.782, 95% CI 1.146-2.771, p=0.010) as independent predictors for liver-related mortality of PBC patients. Conclusion: Fibrosis index and Doha score could serve as valuable prognostic factors for liver-related mortality in Chinese PBC population.