Dynamics of liver stiffness measurement and clinical course of primary biliary cholangitis.
Lam, Laurent Soret, Pierre-Antoine Lemoinne, Sara Hansen, Bettina Hirschfield, Gideon Gulamhusein, Aliya Montano-Loza, Aldo J Lytvyak, Ellina Parés, Albert Olivas, Ignasi
Lam, Laurent
Soret, Pierre-Antoine
Lemoinne, Sara
Hansen, Bettina
Hirschfield, Gideon
Gulamhusein, Aliya
Montano-Loza, Aldo J
Lytvyak, Ellina
Parés, Albert
Olivas, Ignasi
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2024-07-15
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Abstract
Background & aims: In primary biliary cholangitis (PBC), static liver stiffness measurement (LSM) has proven prognostic value. However, the added prognostic value of LSM time course in this disease remains uncertain.
Methods: We conducted an international retrospective cohort study among patients with PBC treated with ursodeoxycholic acid and followed by vibration-controlled transient elastography between 2003 and 2022. Using joint modeling, the association of LSM trajectory and the incidence of serious clinical events (SCE), defined as cirrhosis complications, liver transplantation, or death, was quantified using the hazard ratio and its confidence interval.
Results: A total of 6362 LSMs were performed in 3078 patients (2007 on ursodeoxycholic acid alone; 13% with cirrhosis), in whom 316 SCE occurred over 14,445 person-years (median follow-up, 4.2 years; incidence rate, 21.9 per 1000 person-years). LSM progressed in 59% of patients (mean, 0.39 kPa/year). After adjusting for prognostic factors at baseline, including LSM, any relative change in LSM was associated with a significant variation in SCE risk (P < .001). For example, the adjusted hazard ratios (95% confidence interval) associated with a 20% annual variation in LSM were 2.13 (1.89-2.45) for the increase and 0.40 (0.33-0.46) for the decrease. The association between LSM trajectory and SCE risk persisted regardless of treatment response or duration, when patients with cirrhosis were excluded, and when only death or liver transplantation was considered.
Conclusions: Tracking longitudinal changes in LSM using vibration-controlled transient elastography provides valuable insights into PBC prognosis, offering a robust predictive measure for the risk of SCE. LSM could be used as a clinically relevant surrogate end point in PBC clinical trials.
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Lam L, Soret PA, Lemoinne S, Hansen B, Hirschfield G, Gulamhusein A, Montano-Loza AJ, Lytvyak E, Parés A, Olivas I, Londono MC, Rodríguez-Tajes S, Eaton JE, Osman KT, Schramm C, Sebode M, Lohse AW, Dalekos G, Gatselis N, Nevens F, Cazzagon N, Zago A, Russo FP, Floreani A, Abbas N, Trivedi P, Thorburn D, Saffioti F, Barkai L, Roccarina D, Calvaruso V, Fichera A, Delamarre A, Sobenko N, Villamil AM, Medina-Morales E, Bonder A, Patwardhan V, Rigamonti C, Carbone M, Invernizzi P, Cristoferi L, van der Meer A, de Veer R, Zigmond E, Yehezkel E, Kremer AE, Deibel A, Bruns T, Große K, Wetten A, Dyson JK, Jones D, Levy C, Tanaka A, Dumortier J, Pageaux GP, de Lédinghen V, Carrat F, Chazouillères O, Corpechot C; Global & ERN Rare-Liver PBC Study Groups. Dynamics of Liver Stiffness Measurement and Clinical Course of Primary Biliary Cholangitis. Clin Gastroenterol Hepatol. 2024 Dec;22(12):2432-2441.e2. doi: 10.1016/j.cgh.2024.06.035. Epub 2024 Jul 15.
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