Fluctuating biomarkers in primary sclerosing cholangitis: A longitudinal comparison of alkaline phosphatase, liver stiffness, and ELF.
ALP, alkaline phosphatase
ALT, alanine aminotransferase
AST, aspartate aminotransferase
Alkaline phosphatase
Biomarker
CRP, C-reactive protein
ELF, enhanced liver fibrosis
Elastography
Enhanced liver fibrosis test
FIB-4, Fibrosis-4 Index for Liver Fibrosis
GGT, gamma-glutamyl transferase
HA, hyaluronic acid
ICC, intraclass correlation
INR, international normalised ratio
IgG4, immunoglobulin G4
LSM, liver stiffness measurement
Liver stiffness
PIIINP, propeptide of type III procollagen
PSC, primary sclerosing cholangitis
Primary sclerosing cholangitis
ROI, region of interest
Risk stratification
TE, transient elastography
TIMP-1, tissue inhibitor of metalloproteinases-1
UDCA, ursodeoxycholic acid
ULN, upper limit of normal
pSWE, point shear wave elastography
Journal
JHEP reports : innovation in hepatology
ISSN: 2589-5559
Titre abrégé: JHEP Rep
Pays: Netherlands
ID NLM: 101761237
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
received:
18
12
2020
revised:
25
05
2021
accepted:
16
06
2021
entrez:
6
9
2021
pubmed:
7
9
2021
medline:
7
9
2021
Statut:
epublish
Résumé
Primary sclerosing cholangitis (PSC) is a progressive liver disease characterised by fluctuating liver biochemistries and highly variable disease progression. The Enhanced Liver Fibrosis (ELF®) test and liver stiffness measurements (LSMs) reflect fibrosis and predict clinical outcomes in PSC; however, longitudinal assessments are missing. We aimed to characterise the systematic change in ELF and LSM over time in a prospective cohort of patients with PSC, along with their longitudinal relationship to alkaline phosphatase (ALP) and bilirubin. We included 113 non-transplant PSC patients (86 males [76.1%]; mean age 43.3 ± 15.7 years) with annual study visits between 2013 and 2019 at 2 Norwegian centres. ELF test, LSM, clinical data, liver biochemistries, and revised Mayo risk score were measured. We used linear mixed-effects models to estimate change over time, intraclass correlations (ICCs), and their relationship with ALP and bilirubin. At baseline, the median (range) ELF test was 9.3 (7.5-12.9) and median LSM 1.26 m/s (0.66-3.04 m/s). ELF and LSM increased over time (0.09 point/year, 95% CI [0.03, 0.15], ELF and LSM increased over a 5-year period. Longitudinal analyses demonstrated differences regarding within- and between-patient effects, suggesting that the ELF test may have superior reliability for risk stratification compared with LSM in PSC. Primary sclerosing cholangitis (PSC) is characterised by substantial disease variability between patients and fluctuating liver biochemistries. Hence, new biomarkers are needed to identify individuals with an increased risk of developing end-stage liver disease. We explore the change over time of 2 putative prognostic biomarkers in PSC, the serum Enhanced Liver Fibrosis (ELF®) test and LSMs by ultrasound, demonstrating differences that may reflect differing abilities to discriminate risk.
Sections du résumé
BACKGROUND & AIMS
OBJECTIVE
Primary sclerosing cholangitis (PSC) is a progressive liver disease characterised by fluctuating liver biochemistries and highly variable disease progression. The Enhanced Liver Fibrosis (ELF®) test and liver stiffness measurements (LSMs) reflect fibrosis and predict clinical outcomes in PSC; however, longitudinal assessments are missing. We aimed to characterise the systematic change in ELF and LSM over time in a prospective cohort of patients with PSC, along with their longitudinal relationship to alkaline phosphatase (ALP) and bilirubin.
METHODS
METHODS
We included 113 non-transplant PSC patients (86 males [76.1%]; mean age 43.3 ± 15.7 years) with annual study visits between 2013 and 2019 at 2 Norwegian centres. ELF test, LSM, clinical data, liver biochemistries, and revised Mayo risk score were measured. We used linear mixed-effects models to estimate change over time, intraclass correlations (ICCs), and their relationship with ALP and bilirubin.
RESULTS
RESULTS
At baseline, the median (range) ELF test was 9.3 (7.5-12.9) and median LSM 1.26 m/s (0.66-3.04 m/s). ELF and LSM increased over time (0.09 point/year, 95% CI [0.03, 0.15],
CONCLUSIONS
CONCLUSIONS
ELF and LSM increased over a 5-year period. Longitudinal analyses demonstrated differences regarding within- and between-patient effects, suggesting that the ELF test may have superior reliability for risk stratification compared with LSM in PSC.
LAY SUMMARY
BACKGROUND
Primary sclerosing cholangitis (PSC) is characterised by substantial disease variability between patients and fluctuating liver biochemistries. Hence, new biomarkers are needed to identify individuals with an increased risk of developing end-stage liver disease. We explore the change over time of 2 putative prognostic biomarkers in PSC, the serum Enhanced Liver Fibrosis (ELF®) test and LSMs by ultrasound, demonstrating differences that may reflect differing abilities to discriminate risk.
Identifiants
pubmed: 34485881
doi: 10.1016/j.jhepr.2021.100328
pii: S2589-5559(21)00104-X
pmc: PMC8403583
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100328Informations de copyright
© 2021 The Authors.
Déclaration de conflit d'intérêts
W. Rosenberg is one of the inventors and patent holders of the ELF test. Please refer to the accompanying ICMJE disclosure forms for further details.
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