METABOLIC SYNDROME INDUCES A MORE RAPID PROGRESSION OF FIBROSIS IN PRIMARY BILIARY CIRRHOSIS IN EARLY STAGE

Background and aim: Metabolic syndrome (MS) is a comorbidity, possibly associated to PBC, which increases the risk of cardiovascular events. Transient elastography (TE) is a useful tool for assessing liver fibrosis in PBC, but its performance in longitudinal studies is still scanty. Aim: To assess liver fibrosis progression in patients with PBC (associated or not to MS) using TE after a 2-year interval from the initial diagnosis (histologically confirmed in all patients). Material and methods: Patients and method: A total of consecutive 80 patients with PBC (19 of whom having MS) underwent a prospective TE analysis at baseline and after 2-year interval. The median follow up was 25 months, (range 21–27 months). All patients were treated with UDCA (15 mg/kg/day). MS was defined MS according to the American Heart Association criteria and these patient underwent to specific therapy for MS. Statistical comparison between liver stiffness was conducted usingWilcoxon test. Pearson coefficient of correlation (r) was calculated to analyse the relation between liver stiffness and Mayo score. Results: A significant overall progression of mean liver stiffness (LS) was observed in patients with PBC (8.9±5.5 kPa vs 10.2±7.6 kPa, p=0.0071). No significant difference was observed in fibrosis progression in early histological stage (stage 1) at diagnosis ( 1.4±2.2 kPa, p=0.07), but a significant increase was observed for patient with moderate to advanced fibrosis (stage 2-3-4) ( 1.3±4.8 kPa, p=0.04). No significant difference was observed in the progression of liver stiffness between patients with and without MS ( 1.6±5.8 kPa vs 1.2±4.1 kPa, p=ns). Subgrouping patients according to the histological stage at diagnosis, a significant increase of liver stiffness was observed in stage 2 patients with MS respect to that without MS (p=0.02). Transient elastography positively correlated with Mayo score at diagnosis and after two year of follow-up (r0= 0.35, p<0.05 and r1=0.42, p<0.05). Conclusions: Overall PBC patients treated with UDCA demonstrate a significant progression in LS after 2-year of follow up, especially in the group with moderate to advanced fibrosis at diagnosis. A significant increase on LS was observed in patients with MS and stage 2.