Gut and Liver

The Korean Association for the Study of the Liver (대한간학회)
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Prognostic Value of Biochemical Response Models for Primary Biliary Cholangitis and the Additional Role of the Neutrophil-to-Lymphocyte Ratio

  • Yoo, Jeong-Ju (Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine) ;
  • Cho, Eun Ju (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Lee, Bora (Department of Statistics, Graduate School, Chung-Ang University) ;
  • Kim, Sang Gyune (Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine) ;
  • Kim, Young Seok (Department of Gastroenterology and Hepatology, Soonchunhyang University School of Medicine) ;
  • Lee, Yun Bin (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Lee, Jeong-Hoon (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Yu, Su Jong (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Kim, Yoon Jun (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine) ;
  • Yoon, Jung-Hwan (Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine)
  • Received : 2018.06.12
  • Accepted : 2018.07.27
  • Published : 2018.11.15
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Abstract

Background/Aims: Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been well-validated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. Methods: This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. Results: For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p<0.05). There was no significant difference between the performance of the UK-PBC and GLOBE scores. In addition to the prognostic models, a high NLR (>2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p<0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. Conclusions: The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.

Keywords

References

  1. Hamlyn AN, Macklon AF, James O. Primary biliary cirrhosis: geographical clustering and symptomatic onset seasonality. Gut 1983;24:940-945. https://doi.org/10.1136/gut.24.10.940
  2. European Association for the Study of the Liver. Electronic address eee, European Association for the Study of the L. EASL clinical practice guidelines: the diagnosis and management of patients with primary biliary cholangitis. J Hepatol 2017;67:145-172. https://doi.org/10.1016/j.jhep.2017.03.022
  3. Pares A, Caballeria L, Rodes J. Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic acid. Gastroenterology 2006;130:715-720. https://doi.org/10.1053/j.gastro.2005.12.029
  4. Corpechot C, Abenavoli L, Rabahi N, et al. Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis. Hepatology 2008;48:871-877. https://doi.org/10.1002/hep.22428
  5. Corpechot C, Chazouilleres O, Poupon R. Early primary biliary cirrhosis: biochemical response to treatment and prediction of longterm outcome. J Hepatol 2011;55:1361-1367. https://doi.org/10.1016/j.jhep.2011.02.031
  6. Lammers WJ, Hirschfield GM, Corpechot C, et al. Development and validation of a scoring system to predict outcomes of patients with primary biliary cirrhosis receiving ursodeoxycholic acid therapy. Gastroenterology 2015;149:1804-1812.e4. https://doi.org/10.1053/j.gastro.2015.07.061
  7. Carbone M, Sharp SJ, Flack S, et al. The UK-PBC risk scores: derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis. Hepatology 2016;63:930-950. https://doi.org/10.1002/hep.28017
  8. Muhmmed Suliman MA, Bahnacy Juma AA, Ali Almadhani AA, Pathare AV, Alkindi SS, Uwe Werner F. Predictive value of neutrophil to lymphocyte ratio in outcomes of patients with acute coronary syndrome. Arch Med Res 2010;41:618-622. https://doi.org/10.1016/j.arcmed.2010.11.006
  9. Liu H, Zhang H, Wan G, et al. Neutrophil-lymphocyte ratio: a novel predictor for short-term prognosis in acute-on-chronic hepatitis B liver failure. J Viral Hepat 2014;21:499-507. https://doi.org/10.1111/jvh.12160
  10. Kuiper EM, Hansen BE, de Vries RA, et al. Improved prognosis of patients with primary biliary cirrhosis that have a biochemical response to ursodeoxycholic acid. Gastroenterology 2009;136:1281-1287. https://doi.org/10.1053/j.gastro.2009.01.003
  11. Ripoll C, Groszmann R, Garcia-Tsao G, et al. Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis. Gastroenterology 2007;133:481-488. https://doi.org/10.1053/j.gastro.2007.05.024
  12. Umemura T, Joshita S, Sekiguchi T, et al. Serum wisteria floribunda agglutinin-positive Mac-2-binding protein level predicts liver fibrosis and prognosis in primary biliary cirrhosis. Am J Gastroenterol 2015;110:857-864. https://doi.org/10.1038/ajg.2015.118
  13. Avanzas P, Quiles J, Lopez de Sa E, et al. Neutrophil count and infarct size in patients with acute myocardial infarction. Int J Cardiol 2004;97:155-156. https://doi.org/10.1016/j.ijcard.2003.06.028
  14. Heagerty PJ, Lumley T, Pepe MS. Time-dependent ROC curves for censored survival data and a diagnostic marker. Biometrics 2000;56:337-344. https://doi.org/10.1111/j.0006-341X.2000.00337.x
  15. Papastergiou V, Tsochatzis EA, Rodriguez-Peralvarez M, et al. Biochemical criteria at 1 year are not robust indicators of response to ursodeoxycholic acid in early primary biliary cirrhosis: results from a 29-year cohort study. Aliment Pharmacol Ther 2013;38:1354-1364. https://doi.org/10.1111/apt.12522
  16. Yang F, Yang Y, Wang Q, et al. The risk predictive values of UKPBC and GLOBE scoring system in Chinese patients with primary biliary cholangitis: the additional effect of anti-gp210. Aliment Pharmacol Ther 2017;45:733-743. https://doi.org/10.1111/apt.13927
  17. Cheung KS, Seto WK, Fung J, Lai CL, Yuen MF. Prognostic factors for transplant-free survival and validation of prognostic models in Chinese patients with primary biliary cholangitis receiving ursodeoxycholic acid. Clin Transl Gastroenterol 2017;8:e100. https://doi.org/10.1038/ctg.2017.23
  18. Webb GJ, Hirschfield GM. Primary biliary cholangitis in 2016: high-definition PBC: biology, models and therapeutic advances. Nat Rev Gastroenterol Hepatol 2017;14:76-78. https://doi.org/10.1038/nrgastro.2016.201
  19. de Liso F, Matinato C, Ronchi M, Maiavacca R. The diagnostic accuracy of biomarkers for diagnosis of primary biliary cholangitis (PBC) in anti-mitochondrial antibody (AMA)-negative PBC patients: a review of literature. Clin Chem Lab Med 2017;56:25-31.
  20. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med 2012;5:2. https://doi.org/10.1186/1755-7682-5-2
  21. Dogan I, Karaman K, Sonmez B, Celik S, Turker O. Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction. Nucl Med Commun 2009;30:797-801. https://doi.org/10.1097/MNM.0b013e32832e3a16
  22. Martin HL, Ohara K, Kiberu A, Van Hagen T, Davidson A, Khattak MA. Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer. Intern Med J 2014;44:676-682. https://doi.org/10.1111/imj.12453
  23. Kuo MT, Hu TH, Lu SN, et al. Neutrophil-to-lymphocyte ratio as a predictor of response to peginterferon plus ribavirin therapy for chronic hepatitis C. Dis Markers 2014;2014:462958.
  24. Alkhouri N, Morris-Stiff G, Campbell C, et al. Neutrophil to lymphocyte ratio: a new marker for predicting steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease. Liver Int 2012;32:297-302. https://doi.org/10.1111/j.1478-3231.2011.02639.x
  25. Lin L, Piao M, Jiang X, et al. Does neutrophil-to-lymphocyte ratio predict 1-year mortality in patients with primary biliary cholangitis? Results from a retrospective study with validation cohort. BMJ Open 2017;7:e015304. https://doi.org/10.1136/bmjopen-2016-015304
  26. Li MX, Liu XM, Zhang XF, et al. Prognostic role of neutrophilto-lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis. Int J Cancer 2014;134:2403-2413. https://doi.org/10.1002/ijc.28536
  27. Cai YJ, Dong JJ, Dong JZ, et al. A nomogram for predicting prognostic value of inflammatory response biomarkers in decompensated cirrhotic patients without acute-on-chronic liver failure. Aliment Pharmacol Ther 2017;45:1413-1426. https://doi.org/10.1111/apt.14046

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