A recent analysis of health care claims data published in the Journal of Comparative Effectiveness Research found that a number of abnormal liver test results may predict the risk of negative outcomes in patients with primary biliary cholangitis (PBC). These findings suggest that regularly monitoring these biomarkers could improve care in PBC.
Currently, many guidelines recommend using alkaline phosphatase (ALP) levels to determine the risk of complications. However, some patients with normal ALP levels still experience disease progression. The authors, therefore, tracked liver testing results for patients with PBC over time to determine whether other biomarkers should also be included when evaluating individual risk.
The study included 2,402 adults with PBC who were followed for a median of 2.2 years. The authors defined a negative outcome as the first occurrence of either hospitalization for decompensating events, liver transplant or death. They created statistical models in order to predict the long-term risk of complications.
Overall, 8% of participants experienced an adverse event. Hospitalization was the most common first event, occurring in 4.1% of participants, while liver transplant was the least common first event, occurring in 0.2% of patients.
Read more about PBC prognosis
Patients with abnormal levels of not just ALP but also total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and albumin were at increased risk of all negative clinical outcomes.
When modeling predicted outcomes over five years of follow-up, individuals with elevated TB for at least 12 of those months had a 34% higher risk of negative outcomes. Those with elevated TB for at least 36 of those months had a 140% greater risk of negative outcomes.
Increased levels of ALP, AST and ALT were also linked to risk of adverse events, while those with lower albumin levels were predicted to have worse outcomes.
“These results emphasize the importance of continued biomarker monitoring throughout the disease course,” the authors wrote. “Clinicians and treatment guidelines should expand beyond monitoring only ALP and TB when assessing risk or determining the need to initiate first- or second-line therapy, by incorporating additional biomarkers such as ALT, AST and albumin.”
Sign up here to get the latest news, perspectives, and information about PBC sent directly to your inbox. Registration is free and only takes a minute.
