Natural history and predictors of clinical outcomes in primary biliary cholangitis: a single-center study

Primary biliary cholangitis (PBC) is a chronic cholestatic liver disease with variable long-term clinical outcomes. Understanding its natural history and identifying predictors of outcomes are essential for optimizing patient management. This study aimed to investigate the long-term survival, clinical outcomes, and prognostic factors in patients with PBC. This was a single-center retrospective cohort study conducted at a tertiary referral hospital rather than a dedicated liver transplantation center. Patients aged 18–80 years who were diagnosed with PBC and treated between 2005 and 2020 were enrolled. The primary endpoint was a composite of all-cause death or liver transplantation, and liver-related mortality was defined as liver-related death or liver transplantation. Cumulative survival was estimated using the Kaplan–Meier method and compared using the log-rank test. Univariable and multivariable Cox proportional hazards regression analyses were applied to identify independent prognostic factors. A total of 201 patients with PBC were included. By the end of the study period, 38 (18.91%) patients experienced the composite outcome of all-cause death or liver transplantation. Liver-related mortality occurred in 20 patients (9.95%), comprising 13 liver-related deaths and 7 liver transplantations. For the composite outcome of overall death or liver transplantation, the 5-, 10-, and 15-year cumulative survival rates were 90.5% (95% CI 85.5–93.9%), 83.7% (95% CI 77.0–88.6%), and 71.1% (95% CI 59.9–79.7%), respectively. Multivariable Cox regression analysis identified older age at diagnosis, platelet (PLT) count ≤ 150 × 10⁹/L, aspartate aminotransferase (AST) > 35 U/L, and albumin (Alb) ≤ 35 g/L as independent predictors of overall death or liver transplantation. The final multivariable Cox model showed acceptable discriminative ability, with a Harrell’s C-index of 0.80 (95% CI 0.72–0.88). PLT ≤ 150 × 10⁹/L was also independently associated with liver-related mortality. In this single-center cohort of patients with PBC, older age at diagnosis, thrombocytopenia, elevated AST, and hypoalbuminemia were independently associated with an increased risk of overall death or liver transplantation. These findings suggest that patients with these risk factors may require closer monitoring and timely referral to hepatology or a liver transplantation center when clinically indicated.