Risk factors for esophagogastric variceal-related poor outcomes in primary biliary cholangitis: A prospective cohort study.

BACKGROUND AND AIMS: Esophagogastric varices (EGV) are common complications of primary biliary cholangitis (PBC). We examined the risk factors for variceal bleeding-related liver transplantation (LT) or death.

METHODS

This prospective observational cohort study involved PBC in our hospital from 1 January 2005 to 1 January 2020. The clinical endpoints were variceal bleeding-related LT and death. Survival analysis was performed using the Kaplan-Meier estimate, cox regression analysis was performed to investigate risk factors.

RESULTS

PBC with EGV had significantly shorter survival than those without (p = 0.002). Endoscopic prophylaxis significantly improved poor outcomes in PBC with EGV (p < 0.001). Risk factors in patients with EGV included: cholinesterase (CHE) of <1.0 × upper limit of normal (ULN), international normalized ratio (INR) of >1.2 × ULN at baseline, total bilirubin of >1.2 × ULN, aspartate aminotransferase (AST) of >2.3 × ULN after 1 year of ursodeoxycholic acid (UDCA) treatment, non-biochemical responders according to the Paris criteria, and no history of endoscopic therapy. In PBC without EGV, risk factors included AST of >2.3 × ULN, INR of >1.2 × ULN at baseline, CHE of <1.0 × ULN after 1 year of UDCA treatment, and GLOBE score of >1.125.

CONCLUSION

This study provides evidence that AST, INR and CHE are major risk factors for variceal bleeding-related poor outcomes in PBC. For PBC with EGV, a good biochemical response to UDCA and endoscopic prophylaxis may improve survival. These findings can aid for guiding initial PBC risk stratification and screening endoscopy in patients without EGV.