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Enhanced liver fibrosis score predicts transplant‐free survival in primary sclerosing cholangitis
Author(s) -
Vesterhus Mette,
Hov Johannes Roksund,
Holm Anders,
Schrumpf Erik,
Nygård Ståle,
Godang Kristin,
Andersen Ina Marie,
Næss Sigrid,
Thorburn Douglas,
Saffioti Francesca,
Vatn Morten,
Gilja Odd Helge,
LundJohansen Fridtjof,
Syversveen Trygve,
Brabrand Knut,
Parés Albert,
Ponsioen Cyriel Y.,
Pinzani Massimo,
Färkkilä Martti,
Moum Bjørn,
Ueland Thor,
Røsjø Helge,
Rosenberg William,
Boberg Kirsten Muri,
Karlsen Tom H.
Publication year - 2015
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.27825
Subject(s) - medicine , primary sclerosing cholangitis , gastroenterology , hazard ratio , confidence interval , liver transplantation , proportional hazards model , fibrosis , transplantation , disease
There is a need to determine biomarkers reflecting disease activity and prognosis in primary sclerosing cholangitis (PSC). We evaluated the prognostic utility of the enhanced liver fibrosis (ELF) score in Norwegian PSC patients. Serum samples were available from 305 well‐characterized large‐duct PSC patients, 96 ulcerative colitis patients, and 100 healthy controls. The PSC patients constituted a derivation panel (recruited 1992‐2006 [n = 167]; median age 41 years, 74% male) and a validation panel (recruited 2008‐2012 [n = 138]; median age 40 years, 78% male). We used commercial kits to analyze serum levels of hyaluronic acid, tissue inhibitor of metalloproteinases‐1, and propeptide of type III procollagen and calculated ELF scores by the previously published algorithm. Results were also validated by analysis of ELF tests using the ADVIA Centaur XP system and its commercially available reagents. We found that PSC patients stratified by ELF score tertiles exhibited significantly different transplant‐free survival in both panels ( P < 0.001), with higher scores associated with shorter survival, which was confirmed in the validation panel stratified by ELF test tertiles ( P = 0.003). The ELF test distinguished between mild and severe disease defined by clinical outcome (transplantation or death) with an area under the curve of 0.81 (95% confidence interval [CI] 0.73‐0.87) and optimal cutoff of 10.6 (sensitivity 70.2%, specificity 79.1%). In multivariate Cox regression analysis in both panels, ELF score (hazard ratio = 1.9, 95% CI 1.4‐2.5, and 1.5, 95% CI 1.1‐2.1, respectively) was associated with transplant‐free survival independently of the Mayo risk score (hazard ratio = 1.3, 95% CI 1.1‐1.6, and 1.6, 95% CI 1.2‐2.1, respectively). The ELF test correlated with ultrasound elastography in separate assessments. Conclusion : The ELF score is a potent prognostic marker in PSC, independent of the Mayo risk score. (H epatology 2015;62:188‐197)