SEQUENTIAL-CHANGES IN SERUM LEVELS OF INDIVIDUAL BILE-ACIDS IN PATIENTS WITH CHRONIC CHOLESTATIC LIVER-DISEASE

In order to determine the value of serum bile acids in predicting the course of chronic cholestatic liver diseases, we measured individual s erum bile acids serially, using high-performance liquid chromatography , over a 4 year observation period in 12 patients with primary biliary cirrhosis and six patients with primary sclerosing cholangitis. The c hanges in individual serum bile acids and the ratios thereof, conventi onal liver tests and Child-Turcotte and Mayo scores were compared betw een survivors (n = 10) and patients who underwent liver transplantatio n for (n = 3) or died of the liver disease (n = 5). Patients with a se rum total chenodeoxycholic acid concentration at study entry that exce ded 15 mu mol/L were 10 times more likely to die or need a liver trans plant in the following 4 years than those with chenodeoxycholic acid l evels < 15 mu mol/L (P < 0.05). None of the other biochemical paramete rs or clinicopathological scores could similarly discriminate between the two groups at entry. Time-dependent analyses for the cholic acid/c henodeoxycholic acid ratio, serum total bilirubin and albumin concentr ations and Child-Turcotte and Mayo scores were able to differentiate b etween primary sclerosing cholangitis patients who died or were transp lanted and those who were not, whereas age of the patients and other p arameters did not. The taurocholic acid/taurochenodeoxycholic acid rat io fell during progression of primary biliary cirrhosis but rose in te mporal relationship with primary sclerosing cholangitis. This differen tial pattern of change was unique compared with other clinical and lab oratory indices. In conclusion, serum chenodeoxycholic acid levels and the cholic acid /chenodeoxycholic acid ratio in both diseases were in dependent indices that, allowed for the prediction of survival or the need for liver transplantation. These indices are worthy of further ex amination in a larger group of patients as prognostic criteria for chr onic cholestatic liver disease and in the assessment of the efficacy o f therapeutic interventions, including liver transplantation.