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Analysis of Long-term Observation of 38 Patients

Edward Lebovics, MD; Melissa Palmer, MD; Judy Woo, MD; Fenton Schaffner, MD

Arch Intern Med. 1987;147(4):729-731.

Abstract
• The natural history and prognostic factors of primary sclerosing cholangitis (PSC) are poorly defined. We reviewed our experience with PSC to determine its natural history and whether any factors on presentation or during follow-up were indicative of a favorable or unfavorable prognosis. Thirty-eight patients were followed up for 75.1 ± 58.7 months; 17 (45%) had a poor outcome, defined as the occurrence of death (11 patients [29%]), variceal hemorrhage, hepatic encephalopathy, or hepatic transplantation. We found the following: (1) the rate of progression of PSC is highly variable; (2) an asymptomatic presentation may not indicate a more favorable outcome or prolonged survival; (3) a serum bilirubin value of four times or more the upper limit of normal, particularly if sustained so as to exclude a reversible cause, is indicative of late-stage disease with a likelihood of subsequent poor outcome and death; and (4) variceal hemorrhage may occur before the terminal stage of the disease.

(Arch Intern Med 1987;147:729-731)

Author Affiliations
From the Division of Liver Diseases, Department of Medicine, Mount Sinai School of Medicine of the City University of New York. Dr Lebovics is now with New York Medical College, Valhalla.

Footnotes
Accepted for publication Oct 6,1986.

Reprint requests to Mount Sinai School of Medicine, One Gustave L. Levy Pl, New York, NY 10029 (Dr Schaffner).

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