Gut Liver.
2023 Jul;17(4):620-628. 10.5009/gnl220420.
Clinical Outcomes and Validation of Ursodeoxycholic Acid Response Scores in Patients with Korean Primary Biliary Cholangitis: A Multicenter Cohort Study
- Chang JI
1,2 - Kim JH3
- Sinn DH1
- Cho JY4
- Kim KM5
- Oh JH6
- Park Y7
- Sohn W8
- Goh MJ1
- Kang W1
- Gwak GY1
- Paik YH1
- Choi MS1
- Lee JH1
- Koh KC1
- Paik SW1
- Affiliations
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- 1Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- 2Department of Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Korea
- 3Division of Gastroenterology, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Korea
- 4Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Korea
- 5Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
- 6Department of Medicine, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
- 7Department of Internal Medicine, College of Medicine, Kyung Hee University, Seoul, Korea
- 8Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
- KMID: 2544904
- DOI: http://doi.org/10.5009/gnl220420
Abstract
- Background/Aims
The ursodeoxycholic acid (UDCA) response score (URS) was developed to identify poor responders to UDCA before treatment, in order to offer timely and proactive intervention. However, validation of the URS in Asian population is warranted.
Methods
A total of 173 Asian patients diagnosed with primary biliary cholangitis (PBC) between 2007 and 2016 at seven academic institutions in Korea who started UDCA treatment were analyzed to validate the performance of URS. UDCA response was defined as an alkaline phosphatase level less than 1.67 times the upper limit of normal after 1-year of UDCA treatment. In addition, prognostic performance of URS for liver-related events, defined as newly developed hepatic decompensation or hepatocellular carcinoma was evaluated.
Results
After 1 year of UDCA treatment, 133 patients (76.9%) achieved UDCA response. UDCA response rate was 98.7% for those with URS ≥1.41 (n=76) and 58.8% for those with URS <1.41 (n=97). The area under the receiver operating characteristic curve of URS in predicting UDCA response was 0.84 (95% confidence interval, 0.78 to 0.88). During a median follow-up of 6.5 years, liver-related events developed in 18 patients (10.4%). Among 117 patients with PBC stage I-III by histological evaluation, the 5-year liver-related event-free survival rate differed according to the URS; 100% for URS ≥1.41 and 86.5% for URS <1.41 (p=0.005).
Conclusions
URS demonstrated good performance in predicting a UDCA treatment response in Asian PBC patients. In addition, the risk of liver-related events differed according to the URS for the PBC stage. Thus, URS can be used to predict the response and clinical outcome in patients with PBC.
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