Fossdal, G;
Mjelle, AB;
Wiencke, K;
Bjørk, I;
Gilja, OH;
Folseraas, T;
Karlsen, TH;
... Vesterhus, M; + view all
(2021)
Fluctuating biomarkers in primary sclerosing cholangitis: a longitudinal comparison of alkaline phosphatase, liver stiffness, and ELF.
JHEP Reports
10.1016/j.jhepr.2021.100328.
(In press).
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Abstract
Background & Aims: Primary sclerosing cholangitis (PSC) is a progressive liver disease characterized by fluctuating liver biochemistries and highly variable disease progression. The Enhanced Liver Fibrosis (ELF) test and liver stiffness measurements (LSM) reflect fibrosis and predict clinical outcomes in PSC; however, longitudinal assessments are missing. We aimed to characterize the systematic change in ELF and LSM over time in a prospective PSC cohort, along with their longitudinal relationship to alkaline phosphatase (ALP) and bilirubin. Methods: We included 113 non-transplant PSC patients (86 males [76.1%]; mean age 43.3 ± 15.7 years) with annual study visits between 2013 and 2019 at two Norwegian centers. ELF test, LSM, clinical data, liver biochemistries, and revised Mayo risk score were measured. We used linear mixed-effects models to estimate change over time, intraclass correlations (ICCs), as well as their relationship with ALP and bilirubin. Results: At baseline, the median (range) ELF test was 9.3 (7.5-12.9) and median LSM 1.26 m/s (0.66-3/s). ELF and LSM increased over time (0.09 points/year, 95% CI [0.03-0.15], p=0.005, vs. 0.12 points/year, 95% CI [0.03-0.21], p=0.009). Between-patient effects explained 78% of ELF variation (ICC 0.78), and 56% of LSM variation (ICC 0.56). ALP also increased and showed the highest ICC (0.86). Conclusions: ELF and LSM increased over a 5-year period. Longitudinal analyses demonstrated differences regarding within- and between-patient effects suggesting that the ELF test may have superior reliability for risk stratification compared to LSM in PSC.
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