Forecast

In cases where patients do not have manifestations of the disease, antimitochondrial antibodies are detected in the blood serum , but biochemical parameters of liver function remain within normal values, this indicates the slowly progressive nature of the course of primary biliary cirrhosis. Survival parameters in such patients are close to those in the general population.

In this category of patients, as a rule, 15-20 years elapse from the moment of manifestation of primary biliary cirrhosis (detection of antimitochondrial antibodies in the blood serum) to the terminal stage.

The average life expectancy of patients with asymptomatic primary biliary cirrhosis is 16 years from the moment of diagnosis, and in patients with advanced clinical symptoms this indicator is 7.5 years.

• Prognostic factors in primary biliary cirrhosis

Factors of rapid progression of primary biliary cirrhosis (predictors of rapid disease progression) are:

• Marked pathological changes in liver biopsy samples - small focal (step) necrosis.

• The prevalence of fibrosis.

• The severity of cirrhosis.

• The presence of granulomas.

• Signs of cholestasis.

• The elderly age of patients.

• The presence of edema and ascites.

• Hepatomegaly.

• Hepatic encephalopathy.

• Bleeding from varicose veins.

• The presence of concomitant autoimmune diseases.

• Change in laboratory parameters: bilirubin, albumin, alkaline phosphatase, gamma-glutamyltranspeptidase, immunoglobulin M.

In stage I of primary biliary cirrhosis, clinically severe cirrhosis develops within 5 years in 4% of patients, and in stage III in 59% of patients.

The average duration of transition to stage IV with primary biliary cirrhosis is 25 years for patients with stage I, 20 years for patients with stage II, and only 4 years for patients with stage III.

The most important prognostic factors for primary biliary cirrhosis are: serum bilirubin content and Mayo indicators:

• In patients with a serum bilirubin content of 2-6 mg / dl (34.2-102.6 μmol / L), the average life expectancy is 4.1 years.

• With a serum bilirubin content of 6–10 mg / dl (102.6–170.1 μmol / L), the average life expectancy is 2.1 years.

• In patients with serum bilirubin greater than 10 mg / dL (more than 170.1 μmol / L), the average life expectancy is 1.4 years.

The Mayo Risk Scale is a reliable method for assessing the course of primary biliary cirrhosis, both in vivo and during treatment. Mayo's risk scale provides an opportunity to assess the prognosis of the disease and monitor the effectiveness of treatment. In addition, the Mayo risk scale (Mayo model) allows you to calculate the most optimal time for liver transplantation based on an assessment of 5 indicators (without resorting to an analysis of the histological picture):

• The age of the patient.

• Serum bilirubin content .

• Serum albumin content .

• Prothrombin time.

• The presence of edema or ascites.

Serum bilirubin content (> 17 μmol / L), serum albumin content (<38 g / L) and the severity of step necrosis are independent prognostic factors of primary biliary cirrhosis.