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, 43 (4), 309-13

Alkaline Phosphatase Normalization Is Associated With Better Prognosis in Primary Sclerosing Cholangitis

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Alkaline Phosphatase Normalization Is Associated With Better Prognosis in Primary Sclerosing Cholangitis

Peter P Stanich et al. Dig Liver Dis.

Abstract

Background: Primary sclerosing cholangitis results in elevated but fluctuating serum alkaline phosphatase levels that occasionally return to normal.

Aims: To investigate the frequency of normalization of alkaline phosphatase in newly diagnosed primary sclerosing cholangitis patients and the subsequent clinical outcomes.

Methods: Records of newly diagnosed primary sclerosing cholangitis patients were examined retrospectively for laboratory values and clinical end points (cholangiocarcinoma, liver transplantation and death) within 10 years of diagnosis. Data from a recent prospective ursodeoxycholic acid treatment trial were also studied.

Results: Eighty-seven patients met the inclusion criteria. Normalization of alkaline phosphatase was seen in 35 (40%) patients. Five (14%) patients with normalization reached an end point whereas 17 (33%) of the patients with persistent elevation reached an end point (P = 0.02). Ursodeoxycholic acid was used similarly by both groups. When the investigative criteria were applied to a prospective trial, there was again a significant relationship between normalization of alkaline phosphatase and survival in patients receiving ursodeoxycholic acid (P < 0.01) and the placebo group (P = 0.02).

Conclusions: Serum alkaline phosphatase was found to normalize in a high proportion of newly diagnosed primary sclerosing cholangitis patients. This was significantly associated with a better prognosis in a retrospective cohort and when data from a prospective treatment trial was evaluated.

Figures

Figure 1
Figure 1
Kaplan-Meier analysis of end point-free survival for patients that experienced normalization of alkaline phosphatase (solid line) and patients with persistently abnormal alkaline phosphatase (dashed line) demarcated by years (P=0.02).

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