Bile Acid Profiles in Primary Sclerosing Cholangitis Predict Hepatic Decompensation

Nov 2, 2020 | Konstantinos N. Lazaridis, M.D. | @klazaridis

Altered bile acid (BA) homeostasis, an intrinsic facet of cholestic liver diseases, in primary sclerosing cholangitis (PSC) remains understudied. In a recent publication in Hepatology. Mousa et al., performed BA profiling in a large retrospective cohort of PSC patients and matched healthy controls. The study included 400 PSC patients and 302 controls in the derivation cohort (Mayo Clinic) and 108 PSC patients in the validation cohort (Norwegian PSC Research Center). PSC patients had increased BA levels, conjugated fraction and primary-to-secondary BA ratios relative to controls. UDCA increased total plasma BA level while lowering cholic acid (CA) and chenodeoxycholic acid (CDCA) concentrations. Hepatic decompensation (HD) risk was associated with increased concentration and conjugated fraction of many BA, whereas higher G:T conjugation ratios were protective. The machine learning model, PSC-BAP (bile acid profile) score (C-statistic, 0.95), predicted HD better than individual measures including alkaline phosphatase and performed well in validation (C-statistic, 0.86). The authors concluded that BA profiles predicted future HD, establishing the clinical potential of BA profiling, which may be suited for use in clinical trials.