Background and Aims
A variety of auto‐antibody assays are available as part of the clinical care of patients with liver disease. We sought to better understand the clinical utility of immune serological testing in patients with primary biliary cholangitis (PBC).
Methods
We retrospectively analysed data from 2846 patients investigated for liver disease at a UK liver centre between 2001 and 2017. A total of 499 patients with PBC were identified. Immune serology results were examined for their diagnostic utility and prognostic significance to predict transplant‐free survival.
Results
Antimitochondrial antibodies (AMAs) were specific (94.5%) and sensitive (85.6%) for PBC; antinuclear antibodies (ANAs) against glycoprotein 210 (gp210) and sp100 were specific (>98%) but not sensitive (<25%). The disease‐specific ANAs were detectable in 29.6% of AMA‐negative patients. Anti‐gp210 auto‐antibodies were significantly associated with elevated serum aminotransferase activity, bilirubin and liver stiffness at presentation (P < .010). Anti‐gp210 auto‐antibodies predicted non‐response to ursodeoxycholic acid (UDCA) by GLOBE criteria (39.3% vs 16.7%, P = .005). Moreover, anti‐gp210 was independently associated with death or liver transplantation (HR 3.22, 95% CI 1.49‐6.96; P = .003), after accounting for other significant baseline determinants of outcome. Serologic finding of anti‐gp210 antibodies conferred an independent risk of death or transplantation (HR 4.13, 95% CI 1.85‐9.22; P = .001) after accounting for treatment response.
Conclusion
In our single‐centre cohort of patients with PBC, the presence of anti‐gp210 was associated with an adverse presenting phenotype, predicted treatment non‐response and independently predicted reduced transplant‐free survival.
HCM patients have a significant incidence of screening failure, which is determined primarily by the increased R:T ratio on the screening ECG and lead aVF. High-risk patients have an increased screening failure rate. Optimization of sensing algorithms is required to ensure that the highest risk HCM patients can benefit from S-ICD implantation.
inclusion criteria. Patients were included if they had an increased BMI (!30 or!27.5 in high risk ethnicities) or waist circumference (>94 cm men or >90 cm men high risk ethnicities and >80 cm women) and low alcohol intake (<28 units/ week males or <21 units/week females). AST/ALT ratio, Fibrosis-4-score (FIB-4) and NAFLD score were calculated for each patient. Those with an increased fibrosis score were reviewed in outpatients and had further investigations; non-invasive liver screen, liver ultrasound scan and liver elastography. Results Out of the 82 included patients, 64 (78%) had at least one increased fibrosis score. Twenty-six patients with raised fibrosis score/s were reviewed in outpatient clinic and were offered further investigations. Of 15 patients who had an US scan 10 (66%) had fatty liver and the rest were normal. Twenty-one patients had liver elastography and 1 was found to have possible fibrosis with a fibrosis score of 8.1 kPa. Subsequent liver histology showed fibrosis, however it was thought to be drug induced. Conclusions Informal feedback from the staff performing the NHS Health Check indicated that incorporating the liver screen was not burdensome. However, based on these Results simple fibrosis markers are not a useful screening test for use in primary care, as the high false positive rate Resulted in too many unnecessary referrals to secondary care to exclude fibrosis. It remains unclear how patients with liver fibrosis can be easily identified in primary care.
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