A Longitudinal Assessment of APRI and FIB-4 in Ursodeoxycholic Acid-Responder and Non-Responder Patients With Primary Biliary Cholangitis

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Conference Proceeding

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Introduction Primary biliary cholangitis (PBC) is a chronic autoimmune cholestatic disease characterized by progressive destruction and loss of intrahepatic bile ducts. Ursodeoxycholic acid (UDCA) treatment is used to delay or prevent the progression of the PBC. Biochemical response to UDCA in the first year of treatment and fibrosis stage at the diagnosis are considered to predict long-term outcomes and transplant-free survival in PBC. Aspartate aminotransferase-to-platelet ratio (APRI) and fibrosis index based on four factors (FIB-4) scores are proposed to predict the fibrosis stage in PBC. We aimed to analyze the dynamic changes in APRI and FIB-4 in patients with and without a biochemical response to UDCA as determined by Toronto criteria. Methods Patients with biopsy-proven PBC between the years 1989 to 2020 were identified at our institution. All patients were treated with UDCA, and had at least five years of follow-up. Patients with overlap syndromes on histology were excluded. Clinical and laboratory data were obtained from medical records. APRI and FIB4 scores were calculated at the time of diagnosis, at year one, and at year five follow-up, and compared between UDCA responder vs non-responder patients. Results A total of 60 (58 female, 2 male) patients were included in the study. Patient characteristics and followup data are shown in Image 1. Mean (±SD) age at diagnosis was 50.2 ±12 years. Mean follow-up duration was 12.9 ±6.07 years. Anti-mitochondrial antibody was positive in 41/ 54 (75.9%) of patients. Twenty seven (45%) patients had concurrent autoimmune disorder. Four (6.6%) patients had liver cirrhosis, and 12 (20%) patients had portal hypertension at the time of diagnosis. 20% of patients were non-responsive to UDCA per Toronto criteria. Overall, APRI at the first (0.53±0.63) and fifth year (0.29±0.23) were both lower compared to APRI at the time of diagnosis (0.85±1.23), and it was significantly lower at year five compared to at diagnosis ( p<0.05). Similarly, FIB-4 score was significantly lower at year five (1.19 ±0.61) compared to at diagnosis (1.71 ±1.56, p<0.05). APRI score in UDCA-nonresponder patients at year five (0.28±0.15) was significantly lower compared to APRI score at diagnosis (0.44±0.26, p=0.01). Age, gender, BMI, AMA/AMA M2 positivity, and presence of a concurrent autoimmune disorder were not statistically significant in UDCA-responder vs non-responder patients. Discussion Both APRI and FIB-4 scores were significantly lower at year five as compared to at diagnosis. In UDCA-non-responder patients, APRI was significantly lower at year five compared to at diagnosis; however, FIB-4 was not statistically significant. Our results indicate that even in the absence of a biochemical response to UDCA, APRI may show improvement and should be interpreted carefully.




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