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dc.creatorHarms M.H., Lammers W.J., Thorburn D., Corpechot C., Invernizzi P., Janssen H.L.A., Battezzati P.M., Nevens F., Lindor K.D., Floreani A., Ponsioen C.Y., Mayo M.J., Dalekos G.N., Bruns T., Parés A., Mason A.L., Verhelst X., Kowdley K.V., Goet J.C., Hirschfield G.M., Hansen B.E., Van Buuren H.R.en
dc.date.accessioned2023-01-31T08:27:53Z
dc.date.available2023-01-31T08:27:53Z
dc.date.issued2018
dc.identifier10.1038/ajg.2017.440
dc.identifier.issn00029270
dc.identifier.urihttp://hdl.handle.net/11615/73906
dc.description.abstractObjectives: In this era of near universal ursodeoxycholic acid (UDCA) treatment for primary biliary cholangitis (PBC), progression to cirrhosis still occurs in an important proportion of patients. The aim of this study was to describe the incidence of cirrhosis-associated complications in patients with PBC and assess risk factors and impact on survival. Methods: Cohorts of UDCA-treated patients from 16 European and North-American liver centers were included. We used Cox proportional hazards assumptions and Kaplan-Meier estimates. Results: During 8.1 years' median follow-up, 278 of 3,224 patients developed ascites, variceal bleeding, and/or encephalopathy (incidence rate of 9.7 cases/1,000 patient years). The overall cumulative incidence was 9.1% after 10 years of follow-up, but decreased over time to 5.8% after the year 2000. Earlier calendar year of diagnosis (P<0.001), high aspartate aminotransferase to platelets ratio index (APRI; P<0.001) and biochemical non-response (P<0.001) were independently associated with future complications. Patients with both biochemical non-response and an APRI >0.54 after 12 months of UDCA had a 10-year complication rate of 37.4%, as compared to 3.2% in biochemical responders with an APRI ≤0.54. The 10-year transplantation-free survival after a complication was 9% (time-dependent hazard ratio 21.5; 20.1-22.8). Prognosis after variceal bleeding has improved over time. Conclusions: In this large international cohort, up to 15% of UDCA-treated PBC patients developed major non-neoplastic, cirrhosis-associated hepatic complications within 15 years, but cumulative incidence has decreased over time. Biochemical non-response to UDCA and APRI were independent risk factors for these complications. Subsequent long-term outcome after complications is generally poor, but has improved over the past decades. © 2018 by the American College of Gastroenterology.en
dc.language.isoenen
dc.sourceAmerican Journal of Gastroenterologyen
dc.source.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85042464929&doi=10.1038%2fajg.2017.440&partnerID=40&md5=a4da0ad9b8d16795f67584485498eb69
dc.subjectaspartate aminotransferaseen
dc.subjectursodeoxycholic aciden
dc.subjectaspartate aminotransferaseen
dc.subjectcholagogueen
dc.subjectursodeoxycholic aciden
dc.subjectadulten
dc.subjectArticleen
dc.subjectascitesen
dc.subjectbrain diseaseen
dc.subjectcohort analysisen
dc.subjectcontrolled studyen
dc.subjectdisease courseen
dc.subjectEuropeanen
dc.subjectfemaleen
dc.subjecthepatic encephalopathyen
dc.subjecthumanen
dc.subjectincidenceen
dc.subjectKaplan Meier methoden
dc.subjectliver diseaseen
dc.subjectlong term careen
dc.subjectmajor clinical studyen
dc.subjectmaleen
dc.subjectNorth Americanen
dc.subjectprimary biliary cirrhosisen
dc.subjectpriority journalen
dc.subjectprognosisen
dc.subjectproportional hazards modelen
dc.subjectrisk factoren
dc.subjectsurvivalen
dc.subjecttreatment outcomeen
dc.subjectageden
dc.subjectascitesen
dc.subjectbiliary cirrhosisen
dc.subjectblooden
dc.subjectdisease exacerbationen
dc.subjectesophagus varicesen
dc.subjectEuropeen
dc.subjectgastrointestinal hemorrhageen
dc.subjecthepatic encephalopathyen
dc.subjectmiddle ageden
dc.subjectNorth Americaen
dc.subjectplatelet counten
dc.subjectpopulation growthen
dc.subjectAdulten
dc.subjectAgeden
dc.subjectAscitesen
dc.subjectAspartate Aminotransferasesen
dc.subjectCholagogues and Cholereticsen
dc.subjectCohort Studiesen
dc.subjectDisease Progressionen
dc.subjectEsophageal and Gastric Varicesen
dc.subjectEuropeen
dc.subjectFemaleen
dc.subjectGastrointestinal Hemorrhageen
dc.subjectHepatic Encephalopathyen
dc.subjectHumansen
dc.subjectIncidenceen
dc.subjectKaplan-Meier Estimateen
dc.subjectLiver Cirrhosis, Biliaryen
dc.subjectMaleen
dc.subjectMiddle Ageden
dc.subjectNorth Americaen
dc.subjectPlatelet Counten
dc.subjectPopulation Growthen
dc.subjectPrognosisen
dc.subjectProportional Hazards Modelsen
dc.subjectRisk Factorsen
dc.subjectUrsodeoxycholic Aciden
dc.subjectNature Publishing Groupen
dc.titleMajor hepatic complications in ursodeoxycholic acid-treated patients with primary biliary cholangitis: Risk factors and time trends in incidence and outcomeen
dc.typejournalArticleen


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