African American race does not confer an increased risk of clinical events in patients with primary sclerosing cholangitis.
Journal
Hepatology communications
ISSN: 2471-254X
Titre abrégé: Hepatol Commun
Pays: United States
ID NLM: 101695860
Informations de publication
Date de publication:
01 Feb 2024
01 Feb 2024
Historique:
received:
11
07
2023
accepted:
01
11
2023
medline:
29
1
2024
pubmed:
29
1
2024
entrez:
29
1
2024
Statut:
epublish
Résumé
The natural history of primary sclerosing cholangitis (PSC) among African Americans (AA) is not well understood. Transplant-free survival and hepatic decompensation-free survival were assessed using a retrospective research registry from 16 centers throughout North America. Patients with PSC alive without liver transplantation after 2008 were included. Diagnostic delay was defined from the first abnormal liver test to the first abnormal cholangiogram/liver biopsy. Socioeconomic status was imputed by the Zip code. Among 850 patients, 661 (77.8%) were non-Hispanic Whites (NHWs), and 85 (10.0%) were AA. There were no significant differences by race in age at diagnosis, sex, or PSC type. Inflammatory bowel disease was more common in NHWs (75.8% vs. 51.8% p=0.0001). The baseline (median, IQR) Amsterdam-Oxford Model score was lower in NHWs (14.3, 13.4-15.2 vs. 15.1, 14.1-15.7, p=0.002), but Mayo risk score (0.03, -0.8 to 1.1 vs. 0.02, -0.7 to 1.0, p=0.83), Model for End-stage Liver Disease (5.9, 2.8-10.7 vs. 6.4, 2.6-10.4, p=0.95), and cirrhosis (27.4% vs. 27.1%, p=0.95) did not differ. Race was not associated with hepatic decompensation, and after adjusting for clinical variables, neither race nor socioeconomic status was associated with transplant-free survival. Variables independently associated with death/liver transplant (HR, 95% CI) included age at diagnosis (1.04, 1.02-1.06, p<0.0001), total bilirubin (1.06, 1.04-1.08, p<0.0001), and albumin (0.44, 0.33-0.61, p<0.0001). AA race did not affect the performance of prognostic models. AA patients with PSC have a lower rate of inflammatory bowel disease but similar progression to hepatic decompensation and liver transplant/death compared to NHWs.
Sections du résumé
BACKGROUND
BACKGROUND
The natural history of primary sclerosing cholangitis (PSC) among African Americans (AA) is not well understood.
METHODS
METHODS
Transplant-free survival and hepatic decompensation-free survival were assessed using a retrospective research registry from 16 centers throughout North America. Patients with PSC alive without liver transplantation after 2008 were included. Diagnostic delay was defined from the first abnormal liver test to the first abnormal cholangiogram/liver biopsy. Socioeconomic status was imputed by the Zip code.
RESULTS
RESULTS
Among 850 patients, 661 (77.8%) were non-Hispanic Whites (NHWs), and 85 (10.0%) were AA. There were no significant differences by race in age at diagnosis, sex, or PSC type. Inflammatory bowel disease was more common in NHWs (75.8% vs. 51.8% p=0.0001). The baseline (median, IQR) Amsterdam-Oxford Model score was lower in NHWs (14.3, 13.4-15.2 vs. 15.1, 14.1-15.7, p=0.002), but Mayo risk score (0.03, -0.8 to 1.1 vs. 0.02, -0.7 to 1.0, p=0.83), Model for End-stage Liver Disease (5.9, 2.8-10.7 vs. 6.4, 2.6-10.4, p=0.95), and cirrhosis (27.4% vs. 27.1%, p=0.95) did not differ. Race was not associated with hepatic decompensation, and after adjusting for clinical variables, neither race nor socioeconomic status was associated with transplant-free survival. Variables independently associated with death/liver transplant (HR, 95% CI) included age at diagnosis (1.04, 1.02-1.06, p<0.0001), total bilirubin (1.06, 1.04-1.08, p<0.0001), and albumin (0.44, 0.33-0.61, p<0.0001). AA race did not affect the performance of prognostic models.
CONCLUSIONS
CONCLUSIONS
AA patients with PSC have a lower rate of inflammatory bowel disease but similar progression to hepatic decompensation and liver transplant/death compared to NHWs.
Identifiants
pubmed: 38285883
doi: 10.1097/HC9.0000000000000366
pii: 02009842-202402010-00009
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Association for the Study of Liver Diseases.
Références
Bowlus CL, Arrive L, Bergquist A, Deneau M, Forman L, Ilyas SI, et al. AASLD practice guidance on primary sclerosing cholangitis and cholangiocarcinoma. Hepatology. 2023;77:659–702.
Fickert P, Hirschfield GM, Denk G, Marschall HU, Altorjay I, Farkkila M, et al. norUrsodeoxycholic acid improves cholestasis in primary sclerosing cholangitis. J Hepatol. 2017;67:549–58.
Kowdley KV, Vuppalanchi R, Levy C, Floreani A, Andreone P, LaRusso NF, et al. A randomized, placebo-controlled, phase II study of obeticholic acid for primary sclerosing cholangitis. J Hepatol. 2020;73:94–101.
Lindor KD, Kowdley KV, Luketic VA, Harrison ME, McCashland T, Befeler AS, et al. High-dose ursodeoxycholic acid for the treatment of primary sclerosing cholangitis. Hepatology. 2009;50:808–14.
Trauner M, Gulamhusein A, Hameed B, Caldwell S, Shiffman ML, Landis C, et al. The nonsteroidal farnesoid X receptor agonist cilofexor (GS-9674) improves markers of cholestasis and liver injury in patients with primary sclerosing cholangitis. Hepatology. 2019;70:788–801.
Weismüller TJ, Trivedi PJ, Bergquist A, Imam M, Lenzen H, Ponsioen CY, et al. Patient age, sex, and inflammatory bowel disease phenotype associate with course of primary sclerosing cholangitis. Gastroenterology. 2017;152:1975–84.e1978.
Boonstra K, Weersma RK, van Erpecum KJ, Rauws EA, Spanier BW, Poen AC, et al. Population-based epidemiology, malignancy risk, and outcome of primary sclerosing cholangitis. Hepatology. 2013;58:2045–55.
Kuo A, Gomel R, Safer R, Lindor KD, Everson GT, Bowlus CL. Characteristics and outcomes reported by patients with primary sclerosing cholangitis through an online registry. Clin Gastroenterol Hepatol. 2019;17:1372–8.
Trivedi PJ, Crothers H, Mytton J, Bosch S, Iqbal T, Ferguson J, et al. Effects of primary sclerosing cholangitis on risks of cancer and death in people with inflammatory bowel disease, based on sex, race, and age. Gastroenterology. 2020;159:915–28.
Deneau MR, Mack C, Perito ER, Ricciuto A, Valentino PL, Amin M, et al. The Sclerosing Cholangitis Outcomes in Pediatrics (SCOPE) Index: A prognostic tool for children. Hepatology. 2021;73:1074–87.
Eaton JE, Vesterhus M, McCauley BM, Atkinson EJ, Schlicht EM, Juran BD, et al. Primary Sclerosing Cholangitis Risk Estimate Tool (PREsTo) predicts outcomes of the disease: A Derivation and Validation Study Using Machine Learning. Hepatology. 2020;71:214–24.
Goode EC, Clark AB, Mells GF, Srivastava B, Spiess K, Gelson WTH, et al. Factors associated with outcomes of patients with primary sclerosing cholangitis and development and validation of a risk scoring system. Hepatology. 2019;69:2120–35.
Kim WR, Therneau TM, Wiesner RH, Poterucha JJ, Benson JT, Malinchoc M, et al. A revised natural history model for primary sclerosing cholangitis. Mayo Clin Proc. 2000;75:688–94.
de Vries EM, Wang J, Williamson KD, Leeflang MM, Boonstra K, Weersma RK, et al. A novel prognostic model for transplant-free survival in primary sclerosing cholangitis. Gut. 2018;67:1864–9.
Goldberg DS, Levy C, Yimam K, Gordon SC, Forman L, Verna E, et al. Primary sclerosing cholangitis is not rare among Blacks in a multicenter North American Consortium. Clin Gastroenterol Hepatol. 2018;16:591–3.
Bowlus CL, Li CS, Karlsen TH, Lie BA, Selmi C. Primary sclerosing cholangitis in genetically diverse populations listed for liver transplantation: Unique clinical and human leukocyte antigen associations. Liver Transpl. 2010;16:1324–30.
Berkowitz SA, Traore CY, Singer DE, Atlas SJ. Evaluating area-based socioeconomic status indicators for monitoring disparities within health care systems: Results from a primary care network. Health Serv Res. 2015;50:398–417.
Corpechot C, Gaouar F, El Naggar A, Kemgang A, Wendum D, Poupon R, et al. Baseline values and changes in liver stiffness measured by transient elastography are associated with severity of fibrosis and outcomes of patients with primary sclerosing cholangitis. Gastroenterology. 2014;146:970–79; quiz e915-976.
Eaton JE, Dzyubak B, Venkatesh SK, Smyrk TC, Gores GJ, Ehman RL, et al. Performance of magnetic resonance elastography in primary sclerosing cholangitis. J Gastroenterol Hepatol. 2016;31:1184–90.
Are VS, Vilar-Gomez E, Gromski MA, Akisik F, Lammert C, Ghabril M, et al. Racial differences in primary sclerosing cholangitis mortality is associated with community socioeconomic status. Liver Int. 2021;41:2703–11.
Trivedi PJ, Bowlus CL, Yimam KK, Razavi H, Estes C. Epidemiology, natural history, and outcomes of primary sclerosing cholangitis: A systematic review of population-based studies. Clin Gastroenterol Hepatol. 2022;20:1687–700.
Rosenblatt R, Wahid N, Halazun KJ, Kaplan A, Jesudian A, Lucero C, et al. Black patients have Unequal uccess to listing for liver transplantation in the United States. Hepatology. 2021;74:1523–32.
McClinton A, Gullo J, Martins PN, Serrano OK. Access to liver transplantation for minority populations in the United States. Curr Opin Organ Transplant. 2021;26:508–12.
Robinson A, Hirode G, Wong RJ. Ethnicity and insurance-specific disparities in the Model for End-Stage Liver Disease Score at time of liver transplant waitlist registration and its impact on mortality. J Clin Exp Hepatol. 2021;11:188–94.
Nobel YR, Forde KA, Wood L, Cartiera K, Munoz-Abraham AS, Yoo PS, et al. Racial and ethnic disparities in access to and utilization of living donor liver transplants. Liver Transpl. 2015;21:904–13.
Nsubuga JP, Goyes D, Trivedi HD, Medina-Morales E, Patwardhan V, Bonder A. Waitlist mortality and posttransplant outcomes in African Americans with autoimmune liver diseases. J Transplant. 2021;2021:6692049.
Katz-Greenberg G, Samoylova ML, Shaw BI, Peskoe S, Mohottige D, Boulware LE, et al. Association of the Affordable Care Act on access to and outcomes after kidney or liver transplant: A Transplant Registry Study. Transplant Proc. 2023;55:56–65.
Kumar SR, Khatana SAM, Goldberg D. Impact of Medicaid expansion on liver-related mortality. Clin Gastroenterol Hepatol. 2022;20:419–26 e411.
Fevery J, Van Steenbergen W, Van Pelt J, Laleman W, Hoffman I, Geboes K, et al. Patients with large-duct primary sclerosing cholangitis and Crohn’s disease have a better outcome than those with ulcerative colitis, or without IBD. Aliment Pharmacol Ther. 2016;43:612–20.