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Longitudinal Relationship Between Elevated Liver Biochemical Tests and Negative Clinical Outcomes in Primary Biliary
Kris V Kowdley1, David W Victor2, Joanna P MacEwan3
1Liver Institute Northwest and Elson S. Floyd College of Medicine, Washington State University, Seattle, Washington, USA.
Alimentary Pharmacology & Therapeutics
|April 3, 2025
Summary
Long-term monitoring of liver enzymes and fibrosis scores in primary biliary cholangitis (PBC) patients is crucial. Persistent elevations in biomarkers like ALP, ALT, and AST indicate a higher risk of adverse outcomes, guiding better treatment decisions.
Area of Science:
- Hepatology
- Clinical Biochemistry
- Prognostic Biomarkers
Background:
- Elevated liver biochemistries are linked to poor outcomes in primary biliary cholangitis (PBC).
- Current management often relies on initial treatment response assessment.
Purpose of the Study:
- To determine if ongoing monitoring of liver biochemistries and fibrosis scores offers additional prognostic information in PBC.
- To analyze the relationship between multiple biomarker elevations and alkaline phosphatase (ALP) levels.
Main Methods:
- Adult PBC patients were identified from a healthcare database.
- Cox proportional hazards models assessed the risk of hepatic decompensation, transplantation, or death.
- Time-varying covariates and biomarker thresholds were analyzed within different ALP strata.
Main Results:
- The study included 3974 PBC patients, predominantly female, with a median follow-up of 2.5 years.
- Increased duration and magnitude of elevated ALP, ALT, AST, total bilirubin, APRI, and FIB-4 correlated with higher negative outcome risks.
- These associations held true across all assessed alkaline phosphatase (ALP) levels.
Conclusions:
- Sustained elevation of multiple liver biomarkers and fibrosis scores signifies increased risk for adverse clinical events in PBC.
- Continuous monitoring beyond initial response is vital for timely treatment adjustments and improved patient management.
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