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Hepatology. 2015 Jul;62(1):188-97. doi: 10.1002/hep.27825. Epub 2015 Apr 28.

Enhanced liver fibrosis score predicts transplant-free survival in primary sclerosing cholangitis.

Author information

1
Norwegian PSC Research Center, Department of Transplantation Medicine, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital Rikshospitalet, Oslo, Norway.
2
National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway.
3
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
4
Section of Gastroenterology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway.
5
Research Institute of Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
6
K.G. Jebsen Inflammation Research Centre, University of Oslo, Oslo, Norway.
7
Bioinformatics Core Facility, Institute for Medical Informatics, Oslo University Hospital, Oslo, Norway.
8
Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
9
K.G. Jebsen Cardiac Research Centre and Center for Heart Failure Research, University of Oslo, Oslo, Norway.
10
Section of Specialized Endocrinology, Department of Endocrinology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
11
Department of Medicine, Division of Gastroenterology, Helsinki University Hospital, Helsinki, Finland.
12
UCL Institute for Liver and Digestive Health, Division of Medicine, University College London & Royal Free London, NHS Foundation Trust, London, UK.
13
The Institute of Clinical Epidemiology and Molecular Biology (EpiGen), Campus Ahus, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
14
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
15
Department of Immunology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
16
Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway.
17
Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain.
18
Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
19
Division of Medicine, Department of Gastroenterology, Oslo University Hospital, Oslo, Norway.
20
Division of Medicine, Akershus University Hospital, Lørenskog, Norway.

Abstract

There is a need to determine biomarkers reflecting disease activity and prognosis in primary sclerosing cholangitis (PSC). We evaluated the prognostic utility of the enhanced liver fibrosis (ELF) score in Norwegian PSC patients. Serum samples were available from 305 well-characterized large-duct PSC patients, 96 ulcerative colitis patients, and 100 healthy controls. The PSC patients constituted a derivation panel (recruited 1992-2006 [n = 167]; median age 41 years, 74% male) and a validation panel (recruited 2008-2012 [n = 138]; median age 40 years, 78% male). We used commercial kits to analyze serum levels of hyaluronic acid, tissue inhibitor of metalloproteinases-1, and propeptide of type III procollagen and calculated ELF scores by the previously published algorithm. Results were also validated by analysis of ELF tests using the ADVIA Centaur XP system and its commercially available reagents. We found that PSC patients stratified by ELF score tertiles exhibited significantly different transplant-free survival in both panels (P < 0.001), with higher scores associated with shorter survival, which was confirmed in the validation panel stratified by ELF test tertiles (P = 0.003). The ELF test distinguished between mild and severe disease defined by clinical outcome (transplantation or death) with an area under the curve of 0.81 (95% confidence interval [CI] 0.73-0.87) and optimal cutoff of 10.6 (sensitivity 70.2%, specificity 79.1%). In multivariate Cox regression analysis in both panels, ELF score (hazard ratio = 1.9, 95% CI 1.4-2.5, and 1.5, 95% CI 1.1-2.1, respectively) was associated with transplant-free survival independently of the Mayo risk score (hazard ratio = 1.3, 95% CI 1.1-1.6, and 1.6, 95% CI 1.2-2.1, respectively). The ELF test correlated with ultrasound elastography in separate assessments.

CONCLUSION:

The ELF score is a potent prognostic marker in PSC, independent of the Mayo risk score.

PMID:
25833813
DOI:
10.1002/hep.27825
[Indexed for MEDLINE]
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