P217 Risk factors of primary sclerosing cholangitis and cirrhosis in ulcerative colitis
Z. Azizi*1, Y. Farbod2, S. Javid2, N. Ebrahimi Daryani2, V. Basirat2
1Iran University of medical sciences, Tehran, Iran, Islamic Republic of, 2Tehran university of medical sciences, Tehran, Iran, Islamic Republic of
Primary sclerosing cholangitis (PSC) is an advanced cholestatic liver disease known as an extra manifestation of ulcerative colitis (UC). Despite recent studies, the pathogenesis and potential risk factors of this disease remain an enigma. In this study, we aimed to evaluate predictors of PSC in UC and cirrhosis in PSC patients, in a population of UC patients with and without PSC.
In 2015, a case-control study was conducted on 60 UC patients (38(63.3%) male) in a private gastrointestinal clinic. The cases consisted of 30 UC patients with PSC, along with 30 UC patients without PSC, as controls. Cases were randomly recruited from 1987 to 2015 (mean follow-up time of patients 6.49 ± 5.40 [0–28] years with median of 5 years), and their medical records were collected and analysed from the time of diagnosis to the time of study. All statistical analyses were performed using SPSS software (version 22), and p-value under 0.05 was considered as statistically significant.
Mean age of patients in the UC/PSC and UC/nonPSC groups were 36.73 ± 11.31 (18–64) and 37.26 ± 13.51 (19–75) years respectively. In survival analysis of developing PSC in UC patients, mean survival time was 11.71 ± 1.52, 95% CI (8.7–14.69) years. Further, the 5-, 10-, 15-, and 20-year survival were 79.4%, 37.7%, 28.3%, and 9.4 %. In Cox proportional analysis, age of patients at UC diagnosis (unadjusted hazard ratio [HR] [95% CI 0.94 [0.89–0.98]), age of patients at PSC diagnosis (HR 0.93 [0.88–0.98]), history of cholecystectomy (HR 13.50 [1.50–120.78]), mean percent of patients WBC polymorphonuclears (HR 1.12 [1.02–1.22]), mean percent of positive CRP (HR 1.014 [1.002–1.027]), mean percent of negative CRP (HR 0.98 [0.97–0.99]), mean level of direct bilirubin (HR 3.65 [1.36–9.77]), mean level of AST (HR 1.010 [1.003–1.017]), mean level of ALT (HR 1.008 [1.002–1.014]), and ALP (HR 1.002 [1.0003–1.003]) during follow-up could significantly predict the risk of PSC occurrence in UC patients. Amongst 30 patients with UC/PSC, 20% (6) patients got cirrhosis, with mean survival time of 6.45 ± 0.56, 95% CI (5.34–7.55) years. Moreover, 1-, 2-, and 3-year survival of cirrhosis in PSC patients were 90%, 81.1%, and 76%. In Cox proportional analysis, mean haemoglobin level (HR 0.57 [0.37–0.88]), mean total bilirubin level (HR 1.65 [1.10–2.46]), were significant factors for developing cirrhosis in PSC patients.
Our study showed that age of patients at diagnosis of UC and PSC; mean percent of CRP negativity and positivity; history of cholecystectomy; mean percent of PMN; mean level of direct bilirubin; and AST, ALT, and ALP during follow-up are potential predictors of developing PSC in UC patients. Further, mean Hb and total bilirubin levels during follow-up are significant predictors of developing cirrhosis in PSC patients.