Risk factors for esophagogastric variceal-related poor outcomes in primary biliary cholangitis: A prospective cohort study

Background and aims Esophagogastric varices (EGV) are common complications of primary biliary cholangitis (PBC). We examined the risk factors for variceal bleeding-related liver transplantation (LT) or death. Methods This prospective observational cohort study involved PBC in our hospital from 1 January 2005 to 1 January 2020. The clinical endpoints were variceal bleeding-related LT and death. Survival analysis was performed using the Kaplan–Meier estimate, cox regression analysis was performed to investigate risk factors. Results PBC with EGV had significantly shorter survival than those without (p = 0.002). Endoscopic prophylaxis significantly improved poor outcomes in PBC with EGV (p < 0.001). Risk factors in patients with EGV included: cholinesterase (CHE) of <1.0 × upper limit of normal (ULN), international normalized ratio (INR) of >1.2 × ULN at baseline, total bilirubin of >1.2 × ULN, aspartate aminotransferase (AST) of >2.3 × ULN after 1 year of ursodeoxycholic acid (UDCA) treatment, non-biochemical responders according to the Paris criteria, and no history of endoscopic therapy. In PBC without EGV, risk factors included AST of >2.3 × ULN, INR of >1.2 × ULN at baseline, CHE of <1.0 × ULN after 1 year of UDCA treatment, and GLOBE score of >1.125. Conclusion This study provides evidence that AST, INR and CHE are major risk factors for variceal bleeding-related poor outcomes in PBC. For PBC with EGV, a good biochemical response to UDCA and endoscopic prophylaxis may improve survival. These findings can aid for guiding initial PBC risk stratification and screening endoscopy in patients without EGV.