Predicting the advent of ascites and other complications in primary biliary cirrhosis: a staged model approach

• Published in: Alimentary pharmacology & therapeutics 2010-03, Vol.31 (5), p.573-582
• Main Authors: CHAN, C.‐W., TSOCHATZIS, E. A., CARPENTER, J. R., RIGAMONTI, C., GUNSAR, F., BURROUGHS, A. K.
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Aged; Ascites - etiology; Ascites - mortality; Biological and medical sciences; Cohort Studies; Digestive system; Disease Progression; Edema - etiology; Edema - mortality; Esophageal and Gastric Varices - etiology; Esophageal and Gastric Varices - mortality; Female; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Cirrhosis, Biliary - complications; Liver Cirrhosis, Biliary - mortality; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Meta-Analysis as Topic; Middle Aged; Models, Statistical; Other diseases. Semiology; Peritonitis - etiology; Peritonitis - mortality; Pharmacology. Drug treatments; Prognosis; Risk Factors; Sepsis - etiology; Sepsis - mortality; Survival Analysis; Urinary Tract Infections - etiology; Urinary Tract Infections - mortality
• ISSN: 0269-2813; 1365-2036
• DOI: 10.1111/j.1365-2036.2009.04215.x

Aliment Pharmacol Ther 31, 573–582 Summary Background  Current survival models for primary biliary cirrhosis have limited precision for medium and long‐term survival. Aim  To describe a prognostic model for the advent of complications in primary biliary cirrhosis as the first approach to a staged prognostic model. Methods  From an established database of 289 consecutive primary biliary cirrhosis patients referred to Royal Free Hospital over 12 years (mean follow‐up of 4.1 years), baseline characteristics at referral were evaluated by Cox‐proportional hazards regression modelling. Results  The following complications occurred de novo: 85 ascites/peripheral oedema, 40 oesophagogastric varices, 63 encephalopathy, 29 spontaneous bacterial peritonitis and/or septicaemia, 59 symptomatic urinary tract infections. Age, albumin, log10(bilirubin), presence of ascites at referral, variceal bleeding within 6 weeks before referral, detection of oesophagogastric varices at or before referral were significant at multivariate analysis with different combinations and coefficients for each complication. The model for predicting ascites and/or peripheral oedema best fitted the observed data (ROC = 0.7682, S.E. = 0.0385). Conclusions  The known prognostic factors in primary biliary cirrhosis also model the advent of complications. In view of the prognostic importance of ascites and its more robust statistical model, ascites and/or peripheral oedema could represent, following validation, the most suitable staged model in primary biliary cirrhosis to improve precision in survival modelling.