Prognostic Value of Biochemical Response Models for Primary Biliary Cholangitis and the Additional Role of the Neutrophil-to-Lymphocyte Ratio
2
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Background/Aims: Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been wellvalidated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. Methods: This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. Results: For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p<0.05). There was no significant difference between the performance of the UK-PBC and GLOBE scores. In addition to the prognostic models, a high NLR (>2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p<0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. Conclusions: The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.
Abstract
Background/Aims: Recently reported prognostic models for primary biliary cholangitis (PBC) have been shown to be effective in Western populations but have not been wellvalidated in Asian patients. This study aimed to compare the performance of prognostic models in Korean patients and to investigate whether inflammation-based scores can further help in prognosis prediction. Methods: This study included 271 consecutive patients diagnosed with PBC in Korea. The following prognostic models were evaluated: the Barcelona model, the Paris-I/II model, the Rotterdam criteria, the GLOBE score and the UK-PBC score. The neutrophil-to-lymphocyte ratio (NLR) was analyzed with reference to its association with prognosis. Results: For predicting liver transplant or death at the 5-year and 10-year follow-up examinations, the UK-PBC score (areas under the receiver operating characteristic curve [AUCs], 0.88 and 0.82) and GLOBE score (AUCs, 0.85 and 0.83) were significantly more accurate in predicting prognosis than the other scoring systems (all p<0.05). There was no significant difference between the performance of the UK-PBC and GLOBE scores. In addition to the prognostic models, a high NLR (>2.46) at baseline was an independent predictor of reduced transplant-free survival in the multivariate analysis (adjusted hazard ratio, 3.74; p<0.01). When the NLR was applied to the prognostic models, it significantly differentiated the prognosis of patients. Conclusions: The UK-PBC and GLOBE scores showed good prognostic performance in Korean patients with PBC. In addition, a high NLR was associated with a poorer prognosis. Including the NLR in prognostic models may further help to stratify patients with PBC.
참고문헌 (27)
- Hamlyn AN, "Primary biliary cirrhosis: geographical clustering and symptomatic onset seasonality", Gut, 24, pp.940~945 (1983)
- European Association for the Study of the Liver, "Electronic address eee, European Association for the Study of the L. EASL clinical practice guidelines: the diagnosis and management of patients with primary biliary cholangitis", J Hepatol, 67, pp.145~172 (2017)
- Parés A, "Excellent long-term survival in patients with primary biliary cirrhosis and biochemical response to ursodeoxycholic acid", Gastroenterology, 130 (2006)
- Corpechot C, "Biochemical response to ursodeoxycholic acid and long-term prognosis in primary biliary cirrhosis", Hepatology, 48, pp.871~877 (2008)
- Corpechot C, "Early primary biliary cirrhosis: biochemical response to treatment and prediction of longterm outcome", J Hepatol, 55, pp.1361~1367 (2011)
- Lammers WJ, "Development and validation of a scoring system to predict outcomes of patients with primary biliary cirrhosis receiving ursodeoxycholic acid therapy", Gastroenterology, 149, pp.1804~1812.e4 (2015)
- Carbone M, "The UK-PBC risk scores: derivation and validation of a scoring system for long-term prediction of end-stage liver disease in primary biliary cholangitis", Hepatology, 63, pp.930~950 (2016)
- Muhmmed Suliman MA, "Predictive value of neutrophil to lymphocyte ratio in outcomes of patients with acute coronary syndrome", Arch Med Res, 41, pp.618~622 (2010)
- Liu H, "Neutrophil-lymphocyte ratio: a novel predictor for short-term prognosis in acute-on-chronic hepatitis B liver failure", J Viral Hepat, 21, pp.499~507 (2014)
- Kuiper EM, "Improved prognosis of patients with primary biliary cirrhosis that have a biochemical response to ursodeoxycholic acid", Gastroenterology, 136, pp.1281~1287 (2009)
- Ripoll C, "Hepatic venous pressure gradient predicts clinical decompensation in patients with compensated cirrhosis", Gastroenterology, 133, pp.481~488 (2007)
- Umemura T, "Serum wisteria floribunda agglutinin-positive Mac-2-binding protein level predicts liver fibrosis and prognosis in primary biliary cirrhosis", Am J Gastroenterol, 110, pp.857~864 (2015)
- Avanzas P, "Neutrophil count and infarct size in patients with acute myocardial infarction", Int J Cardiol, 97, pp.155~156 (2004)
- Heagerty PJ, "Time-dependent ROC curves for censored survival data and a diagnostic marker", Biometrics, 56, pp.337~344 (2000)
- Papastergiou V, "Biochemical criteria at 1 year are not robust indicators of response to ursodeoxycholic acid in early primary biliary cirrhosis: results from a 29-year cohort study", Aliment Pharmacol Ther, 38, pp.1354~1364 (2013)
- Yang F, "The risk predictive values of UKPBC and GLOBE scoring system in Chinese patients with primary biliary cholangitis: the additional effect of anti-gp210", Aliment Pharmacol Ther, 45, pp.733~743 (2017)
- Cheung KS, "Prognostic factors for transplant-free survival and validation of prognostic models in Chinese patients with primary biliary cholangitis receiving ursodeoxycholic acid", Clin Transl Gastroenterol, 8, pp.e100~ (2017)
- Webb GJ, "Primary biliary cholangitis in 2016: high-definition PBC: biology, models and therapeutic advances", Nat Rev Gastroenterol Hepatol, 14, pp.76~78 (2017)
- de Liso F, "The diagnostic accuracy of biomarkers for diagnosis of primary biliary cholangitis (PBC) in anti-mitochondrial antibody (AMA)-negative PBC patients: a review of literature", Clin Chem Lab Med, 56, pp.25~31 (2017)
- Imtiaz F, "Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population", Int Arch Med, 5, pp.2~ (2012)
- Dogan I, "Relationship between serum neutrophil count and infarct size in patients with acute myocardial infarction", Nucl Med Commun, 30, pp.797~801 (2009)
- Martin HL, "Prognostic value of systemic inflammation-based markers in advanced pancreatic cancer", Intern Med J, 44, pp.676~682 (2014)
- Kuo MT, "Neutrophil-to-lymphocyte ratio as a predictor of response to peginterferon plus ribavirin therapy for chronic hepatitis C", Dis Markers, 2014, pp.462958~ (2014)
- Alkhouri N, "Neutrophil to lymphocyte ratio: a new marker for predicting steatohepatitis and fibrosis in patients with nonalcoholic fatty liver disease", Liver Int, 32, pp.297~302 (2012)
- Lin L, "Does neutrophil-to-lymphocyte ratio predict 1-year mortality in patients with primary biliary cholangitis? Results from a retrospective study with validation cohort", BMJ Open, 7(015304), pp.e015304~ (2017)
- Li MX, "Prognostic role of neutrophilto- lymphocyte ratio in colorectal cancer: a systematic review and meta-analysis", Int J Cancer, 134, pp.2403~2413 (2014)
- Cai YJ, "A nomogram for predicting prognostic value of inflammatory response biomarkers in decompensated cirrhotic patients without acute-on-chronic liver failure", Aliment Pharmacol Ther, 45, pp.1413~1426 (2017)