Liver fibrosis progression predicts survival in patients with primary biliary cirrhosis.

Abstract

AimThe prognosis and natural history of primary biliary cirrhosis (PBC) has improved, and the clinical end‐point for PBC needs to be discovered. We aimed to identify surrogate markers for predicting long‐term prognosis in patients with PBC.MethodsA total of 106 patients were divided into 53 responders and 53 non‐responders based on the median rate (69%) of decrease in γ‐glutamyl transpeptidase levels at 1 year after initiating ursodeoxycholic acid therapy. We aimed to identify the differences between ursodeoxycholic acid responders and non‐responders. Correlation of patient survival with histologic parameters based on Scheuer and Nakanuma staging systems was investigated. The Nakanuma system comprises grading for liver fibrosis and bile duct loss (BDL).ResultsThe baseline pathological stage was the only factor that showed differences between the two groups. Patients in Scheuer stage 1 had a significantly better prognosis than patients in Scheuer stages 3 or 4 (P < 0.05 and P < 0.01, respectively), whereas patients in Nakanuma stage 1 had significantly better prognosis than patients in Nakanuma stage 4 (P < 0.01). Patients with Nakanuma fibrosis scores 2 and 3 had decreased survival compared with patients with fibrosis score 0 (P < 0.05 and P < 0.01, respectively), whereas patients with Nakanuma BDL score 3 had decreased survival compared with patients with BDL score 0 (P < 0.01).ConclusionLong‐term prognosis could be predicted by Scheuer stage 3 and Nakanuma fibrosis score 2, which were referred to as portal‐bridging fibrosis. Liver fibrosis has greater utility in predicting long‐term prognosis than BDL.