P0728 - Autoimmune Hepatitis-Primary Biliary Cholangitis Overlap Syndrome: In Search of Surrogate Markers of Advanced Hepatic Fibrosis

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Jesus E. Romero, MD

Liver Associates of Texas, PA
Elizabeth , NJ, United States

Jesus E. Romero, MD¹, Natalie N. Nguyen, BS², Ana Romero, MD¹, Mrinalini Buddha, MD, MPH¹, Quynh-An Phan, BS¹, Chukwuma Egwim, MD³, Victor Ankoma-Sey, MD¹
¹Liver Associates of Texas, PA, Houston, TX; ²Baylor College of Medicine, Houston, TX; ³Liver Assosciates of Texas, PA, Houston, TX

Introduction: Overlap syndrome is a term that describes a clinical condition characterized by the presence of autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC). AIH-PBC is the most common form of this syndrome representing 10% of adults with AIH or PBC. The Paris criteria are the most common diagnostic parameters used in this pathology which includes features of both disorders. Our study aim was to determine which fibrosis score was significantly correlated with patients with AIH-PBC overlap syndrome.

Methods: A retrospective cross-sectional study was conducted at Liver Associates of Texas Hepatology clinics in Houston, Texas. Included were patients diagnosed with AIH-PBC Overlap syndrome between January 2018- May 2021. Antibodies, liver function tests, and liver biopsy were used to determine the presence of PBC and AIH. Elastography was used to determine liver stiffness measurements (LSM) in kPa. APRI, FIB-4, and Mayo PBC scores were also calculated. A multivariate linear regression was used to determine the compare correlation of APRI, FIB-4, and Mayo PBC scores to liver stiffness measurements. ROC curve was also performed for all scores.

Results: 37 patients were included in this study. 15 were Caucasian, 6 Hispanic, 7 African American, 1 Asian, 7 African American, and 1 unspecified. The median age was 63 years old, and 34 patients were female. APRI score was found to have statistically significant correlation to LSM with a positive correlation (p = 0.029) but not with FIB-4 (p = 0.431) or Mayo score (p = 0.877). ROC curve for APRI was performed and the determined cut-off point for significant fibrosis is 0.3245 (100% sensitivity, 66.67% specificity, AUC = 0.833).

Discussion: In our population of PBC-AIH overlap patients, APRI was found to be a good candidate for the non-invasive measure of liver fibrosis. Further studies need to be performed with to determine which score is the best surrogate marker of fibrosis in these patients.

Figure: Title: ROC curve for APRI scores.

Predictor	p – value	Estimate	95% CI	Sn	Sp	AUC
APRI	0.029*	28.084	(0.131 – 1.832)	1.00	0.667	0.883
FIB-4	0.431	-1.936	(-1.187 – 0.559)	1.00	0.333	0.556
Mayo	0.877	0.483	(-0.539 – 0.691)	0.25	1.00	0.469

Table: Title: Correlation between fibrosis scores and kPa in patients with PBC-AIH overlap syndrome. APRI= aspartate aminotransferase to platelet ratio index, FIB-4 = Fibrosis 4 score, * = Statistically significant to the 95% CI, CI = Confidence Interval, Sn = sensitivity, Sp = specificity, AUC = Area Under the Curve.

Disclosures:
Jesus Romero indicated no relevant financial relationships.
Natalie Nguyen indicated no relevant financial relationships.
Ana Romero indicated no relevant financial relationships.
Mrinalini Buddha indicated no relevant financial relationships.
Quynh-An Phan indicated no relevant financial relationships.
Chukwuma Egwim: Allergan plc – Grant/Research Support. Genfit – Grant/Research Support. Gilead Sciences – Other Financial or Material Support, Speaking/Teaching. Intercept Pharmaceuticals – Grant/Research Support. Madrigal Pharmaceuticals – Grant/Research Support. NorthSea Therapeutics – Grant/Research Support.
Victor Ankoma-Sey: Abbvie – Other Financial or Material Support, Teaching/Speaking. Allergan plc – Grant/Research Support. Genfit – Grant/Research Support. Gilead Sciences – Other Financial or Material Support, Speaking/Teaching. Intercept Pharmaceuticals – Grant/Research Support, Other Financial or Material Support, Teaching/Speaking. Madrigal Pharmaceuticals – Grant/Research Support. NorthSea Therapeutics – Grant/Research Support.

Jesus E. Romero, MD¹, Natalie N. Nguyen, BS², Ana Romero, MD¹, Mrinalini Buddha, MD, MPH¹, Quynh-An Phan, BS¹, Chukwuma Egwim, MD³, Victor Ankoma-Sey, MD¹. P0728 - Autoimmune Hepatitis-Primary Biliary Cholangitis Overlap Syndrome: In Search of Surrogate Markers of Advanced Hepatic Fibrosis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.