Measurement of Gamma Glutamyl Transferase to Determine Risk of Liver Transplantation or Death in Patients With Primary Biliary Cholangitis.
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Gerussi Alessio, Bernasconi Davide Paolo, O'Donnell Sarah Elisabeth, Lammers Willem J, Van Buuren Henk, Hirschfield Gideon, Janssen Harry, Corpechot Christophe, Reig Anna, Pares Albert, Battezzati Pier Maria, Zuin Massimo Giovanni, Cazzagon Nora, Floreani Annarosa, Nevens Frederik, Gatselis Nikolaos, Dalekos George, Mayo Marlyn J, Thorburn Douglas, Bruns Tony, Mason Andrew L, Verhelst Xavier, Kowdley Kris, van der Meer Adriaan, Niro Grazia Anna, Beretta-Piccoli Benedetta Terziroli, Marzioni Marco, Belli Luca Saverio, Marra Fabio, Valsecchi Maria Grazia, Lindor Keith D, Invernizzi Pietro, Hansen Bettina E, Carbone Marco, Italian PBC Study Group and the GLOBAL PBC Study Group
Аннотация
METHODS: We analyzed data from patients with PBC from the Global PBC Study Group, comprising 14 centers in Europe and North America. We obtained measurements of serum GGT at baseline and time points after treatment. We used Cox model hazard ratios to evaluate the association between GGT and clinical outcomes, including liver transplantation and liver-related death.
RESULTS: Of the 2129 patients included in our analysis, 281 (13%) had a liver-related clinical endpoint. Mean age at diagnosis was 53 years and 91% of patients were female patients. We found a correlation between serum levels of GGT and alkaline phosphatase (ALP) (r = 0.71). Based on data collected at baseline and yearly for up to 5 years, higher serum levels of GGT were associated with lower hazard for transplant-free survival. Serum level of GGT at 12 months after treatment higher than 3.2-fold the upper limit of normal (ULN) identified patients who required liver transplantation or with liver-related death at 10 years with an area under the receiver operating characteristic curve of 0.70. The risk of liver transplantation or liver-related death in patients with serum level of GGT above 3.2-fold the ULN, despite level of ALP lower than 1.5-fold the ULN, was higher compared to patients with level of GGT lower than 3.2-fold the ULN and level of ALP lower than 1.5-fold the ULN (P < .05). Including information on level of GGT increased the prognostic value of the Globe score.
CONCLUSIONS: Serum level of GGT can be used to identify patients with PBC at risk for liver transplantation or death, and increase the prognostic value of ALP measurement. Our findings support the use of GGT as primary clinical endpoint in clinical trials. In patients with low serum level of ALP, a high level of GGT identifies those who might require treatment of metabolic disorders or PBC treatment escalation.