A recent study published in the Journal of Gastroenterology found that patients with primary biliary cholangitis (PBC) and decompensated cirrhosis can achieve recompensation.
Decompensation refers to the state in which the liver is severely damaged and can no longer function properly. In some patients with liver disease recompensation can occur, meaning this damage reverses.
Currently, there is no single clear definition of recompensation in patients with PBC, because the underlying cause of the disease remains poorly understood. The study authors sought to determine a set of criteria for recompensation and reversal of disease progression.
The study included 240 patients with PBC and cirrhosis. Of these, 118 had decompensated cirrhosis at baseline. While 56 participants developed decompensation before beginning treatment with ursodeoxycholic acid (UCDA), 62 experienced decompensation after at least one year of treatment.
Read more about PBC causes and risk factors
The researchers found that 15.3% of patients achieved recompensation, defined by stable liver function, absence of variceal hemorrhage (bleeding due to the rupture of enlarged veins), and improvements in fluid buildup and hepatic encephalopathy (a brain disease cause by liver dysfunction) for at least 12 months. When expanding the definition to include individuals still receiving diuretics or lactulose, 26.3% achieved recompensation.
Patients who developed decompensation before beginning UCDA where significantly more likely to experience recompensation than those who developed decompensation after beginning treatment.
Participants experiencing recompensation had milder liver disease than those who did not. Additionally, those with variceal hemorrhage alone were more likely to achieve recompensation than those with ascites (abdominal fluid buildup) and/or hepatic encephalopathy.
Of note, the risk of negative long-term outcomes was not significantly different between recompensated and compensated patients.
“Collectively, these findings support the clinical utility of recompensation as a therapeutic endpoint in decompensated patients with PBC,” the authors concluded. “Incorporating recompensation assessment into management frameworks could enhance risk stratification and guide long-term care after validated by future prospective studies with larger number of patients and longer follow-up.”
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