Study Observes Delay From Lab Abnormalities to Diagnosis of PBC

By
Kerri Fitzgerald
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A study presented at the AASLD Liver Meeting found that, on average, the time from symptom onset and/or laboratory abnormalities to primary biliary cholangitis (PBC) diagnosis can be more than 3 years.

PBC is a progressive condition that can lead to cirrhosis and potentially liver transplantation, so early detection and diagnosis are important.

Researchers conducted a retrospective review of 163 patients (92% female; mean age, 61 years) with antimitochondrial autoantibodies (AMA)-positive PBC from Rush University Medical Center between 2017 and 2022 to assess the time between lab abnormalities to AMA testing and PBC diagnosis.

Researchers created a point system that assigned 1 point each to the following characteristics:

  • Female sex;
  • Age greater than 40 years;
  • Presence of pruritus;
  • Alkaline phosphatase (ALP) greater than 120; and
  • ALP greater than 250.

The average time from positive AMA result to PBC diagnosis was 94 days.

The average delay from detection of first lab abnormality to PBC diagnosis was:

  • 1,030 days for ALP;
  • 923 days for aspartate aminotransferase;
  • 935 days for alanine aminotransferase; and
  • 401 days for total bilirubin.

Based on the point system, the average delay to diagnosis was:

  • 833 days for 2 points (n=20; 12.3%);
  • 1,366 days for 3 points (n=99; 55.2%);
  • 472 days for 4 points (n=39; 23.9%);
  • 106 days for 5 points (n=13; 8%).

“This study highlights a significant delay in PBC diagnosis from initial symptom onset and/or abnormal ALP result, with an average delay of more than 3 years,” the authors concluded. “The low rate of AMA testing and hepatology referrals suggests the need for development of diagnostic criteria and continued medical education to appropriately screen women aged greater than 40 with elevated ALP for PBC.”

Reference

Morales AMD, Reau N, Post Z, Boupapanh K. Diagnostic delay limits early recognition of primary biliary cholangitis. Abstract 4265. Presented at the 2024 American Association for the Study of Liver Diseases’ 75th Liver Meeting; November 15–19, 2024; San Diego.

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