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 Alkaline phosphatase normalization is a biomarker of improved survival in primary sclerosing cholangitis.
Hilscher, Moira; Enders, Felicity B; Carey, Elizabeth J; Lindor, Keith D; Tabibian, James H.
Afiliação
  • Hilscher M; Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
  • Enders FB; Division of Biomedical Statistics & Informatics, Mayo Clinic, Rochester, MN, USA.
  • Carey EJ; Division of Gastroenterology & Hepatology, Mayo Clinic, Scottsdale, AZ, USA.
  • Lindor KD; Executive Vice Provost & Dean, College of Health Solutions, Arizona State University, Phoenix, AZ, USA; Division of Gastroenterology & Hepatology. Mayo Clinic, Scottsdale, AZ.
  • Tabibian JH; Division of Gastroenterology & Hepatology, Mayo Clinic, Rochester, MN, USA.
Ann Hepatol ; 15(2): 246-53, 2016.
Article em En | MEDLINE | ID: mdl-26845602
UNLABELLED:  Introduction. Recent studies suggest that serum alkaline phosphatase may represent a prognostic biomarker in patients with primary sclerosing cholangitis. However, this association remains poorly understood. Therefore, the aim of this study was to investigate the prognostic significance and clinical correlates of alkaline phosphatase normalization in primary sclerosing cholangitis. MATERIAL AND METHODS: This was a retrospective cohort study of patients with a new diagnosis of primary sclerosing cholangitis made at an academic medical center. The primary endpoint was time to hepatobiliaryneoplasia, liver transplantation, or liver-related death. Secondary endpoints included occurrence of and time to alkaline phosphatase normalization. Patients who did and did not achieve normalization were compared with respect to clinical characteristics and endpoint-free survival, and the association between normalization and the primary endpoint was assessed with univariate and multivariate Cox proportional-hazards analyses. RESULTS: Eighty six patients were included in the study, with a total of 755 patient-years of follow-up. Thirty-eight patients (44%) experienced alkaline phosphatase normalization within 12 months of diagnosis. Alkaline phosphatase normalization was associated with longer primary endpoint-free survival (p = 0.0032) and decreased risk of requiring liver transplantation (p = 0.033). Persistent normalization was associated with even fewer adverse endpoints as well as longer survival. In multivariate analyses, alkaline phosphatase normalization (adjusted hazard ratio 0.21, p = 0.012) and baseline bilirubin (adjusted hazard ratio 4.87, p = 0.029) were the only significant predictors of primary endpoint-free survival. CONCLUSIONS: Alkaline phosphatase normalization, particularly if persistent, represents a robust biomarker of improved long-term survival and decreased risk of requiring liver transplantation in patients with primary sclerosing cholangitis.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Colangite Esclerosante / Transplante de Fígado / Fosfatase Alcalina Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2016 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: México

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Colangite Esclerosante / Transplante de Fígado / Fosfatase Alcalina Tipo de estudo: Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged Idioma: En Revista: Ann Hepatol Assunto da revista: GASTROENTEROLOGIA Ano de publicação: 2016 Tipo de documento: Article País de afiliação: Estados Unidos País de publicação: México