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. 2022 Jul 15;6(8):577-586.
doi: 10.1002/jgh3.12789. eCollection 2022 Aug.

Cumulative risk of developing a new symptom in patients with primary biliary cholangitis and its impact on prognosis

Naruhiro Kimura  1 , Toru Setsu  1 , Yoshihisa Arao  1 , Norihiro Sakai  1 , Yusuke Watanabe  1 , Hiroyuki Abe  1 , Hiroteru Kamimura  1 , Akira Sakamaki  1 , Takeshi Yokoo  1 , Kenya Kamimura  1 , Atsunori Tsuchiya  1 , Akihiko Osaki  2 , Kentarou Igarashi  2 , Nobuo Waguri  2 , Masahiko Yanagi  3 , Toru Takahashi  3 , Soichi Sugitani  4 , Yuka Kobayashi  5 , Masaaki Takamura  5 , Akira Yoshikawa  5 , Toru Ishikawa  6 , Toshiaki Yoshida  6 , Toshiaki Watanabe  7 , Hitoshi Bannai  8 , Tomoyuki Kubota  9 , Kazuhiro Funakoshi  10 , Hiroto Wakabayashi  11 , So Kurita  12 , Norio Ogata  12 , Masashi Watanabe  13 , Yuhsaku Mita  14 , Shigeki Mori  15 , Motoya Sugiyama  16 , Toru Miyajima  17 , Sumio Takahashi  18 , Shuichi Sato  19 , Kisei Ishizuka  20 , Hironobu Ohta  20 , Yutaka Aoyagi  18 , Shuji Terai  1
Affiliations

Cumulative risk of developing a new symptom in patients with primary biliary cholangitis and its impact on prognosis

Naruhiro Kimura et al. JGH Open. .

Abstract

Background and aim: Symptoms of primary biliary cholangitis (PBC) frequently impair one's quality of life (QOL). Nonetheless, with improved treatment, the prognosis of PBC also improves. QOL plays an important role in patients with PBC. In this study, we aimed to reevaluate the transition of new symptom development in PBC and its predictive factors.

Methods: This retrospective multicenter study enrolled 382 patients with PBC for symptom analysis. The impact of a newly developed symptom on PBC prognosis was investigated by Kaplan-Meier analysis with propensity score matching and logistic progression analysis.

Results: The cumulative risk of developing a new symptom after 10 and 20 years of follow-up was 7.6 and 28.2%, and specifically that of pruritus, which was the most common symptom, was 6.7 and 23.3%, respectively. In Cox hazard risk analysis, serum Alb level (hazard ratio [HR], 1.097; 95% confidence interval [CI], 1.033-1.165; P = 0.002), the serum D-Bil level (HR, 6.262; 95% CI, 2.522-15.553, P < 0.001), and Paris II criteria (HR, 0.435; 95% CI, 0.183-1.036; P = 0.037) were significant independent predictors of a new symptom. Kaplan-Meier analysis showed that the overall survival and liver-related death were not significant between patients with and without a new symptom.

Conclusion: The cumulative risk of new symptom development is roughly 30% 20 years after diagnosis and could be predicted by factors including serum albumin levels, serum D-Bil level, and Paris II criteria.

Keywords: cholangitis; propensity score; quality of life; serum albumin.

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Figures

Figure 1
Figure 1
Strategy of this study. A total of 483 with primary biliary cholangitis were enrolled. After exclusion based on the study's criteria, 382 patients were analyzed, as reflected in Tables 1, 2, and 3 and Figure 2. These patients were reanalyzed (Fig. 3) by propensity score matching analysis using factors such as autoimmune disease occurrence, serum albumin level, serum direct bilirubin level, bezafibrate usage, and Paris II criteria, which showed significance in Table 3.
Figure 2
Figure 2
Kaplan–Meier analysis of the cumulative ratio for newly developed symptoms. Kaplan–Meier analysis showed the individual cumulative ratios of newly developed symptoms including pruritus, jaundice, ascites, edema, encephalopathy, and varices.
Figure 3
Figure 3
Kaplan–Meier analysis of survival ratio with or without new symptom. Propensity score matching analysis determined by logistic progression analysis showed no significance in both the overall survival and liver‐related death between patients with and without a new symptom (a) and between patients with and without an initial symptom (b).
See this image and copyright information in PMC

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