Inflammatory bowel disease type influences development of elevated liver enzymes

• Published in: JGH open Vol. 6; no. 12; pp. 846 - 853
• Main Authors: Cheng, Yao‐Wen, McLean, Richard, Sewell, Justin L, Huang, Chiung‐Yu, Khalili, Mandana
• Format: Journal Article
• Language: English
• Published: Melbourne Wiley Publishing Asia Pty Ltd 01-12-2022; John Wiley & Sons, Inc; Wiley
• Subjects: Age; Body mass index; Crohn's disease; Diabetes; Drug use; Enzymes; Etiology; Gastroenterology; HIV; Hospitals; Human immunodeficiency virus; Hyperlipidemia; Hypertension; Inflammatory bowel disease; Laboratories; liver disease; Liver diseases; Males; Medical records; Original; Patients; Phosphatase; Risk factors; Steroids; transaminitis; ulcerative colitis; Variables; United States > US; San Francisco California; Crohn's disease; transaminitis; ulcerative colitis; liver disease; inflammatory bowel disease
• ISSN: 2397-9070; 2397-9070
• DOI: 10.1002/jgh3.12831

Background and Aim
Up to a third of patients with inflammatory bowel disease (IBD) have elevated liver enzymes (ELE). We evaluated the incidence, predictors, and outcomes associated with ELE in a diverse and vulnerable IBD cohort.
Methods
We retrospectively evaluated 336 IBD patients receiving care at the San Francisco safety net gastroenterology clinics between June 1996 and December 2019. Baseline characteristics were captured at first visit, then patients were followed until last clinic activity or death. Testing and etiology, pattern of ELE defined as transient (<1 month) or persistent (≥1 month), were assessed. Multivariate modeling evaluated predictors of ELE at baseline, new ELE at follow‐up, and pattern of ELE.
Results
Baseline median age was 40.3 years, 62% male, 46% White (13% Black, 19% Asian, and 18% Latino), and 59% had ulcerative colitis (UC). Among those without known liver disease (n = 14), 51.6% (166 of 322; 52 at baseline, 114 during follow‐up) had ELE. In multivariate logistic regression, 5‐aminosalicylic acid use (odds ratio [OR] 2.2, 95% confidence interval [CI]: 1.07–4.4, P = 0.03) and higher body mass index (OR 1.08, 95% CI: 1.02–1.14, P = 0.01) were associated with baseline ELE. In multivariate Cox regression, UC (vs. Crohn's disease [CD]) had a 34% lower risk of developing new ELE during follow‐up (hazard ratio [HR] 0.66, 95% CI: 0.46–0.95, P = 0.02). Mortality rate was higher for patients with ELE (0% normal vs 2.3% transient ELE vs 6.5% persistent ELE, P < 0.001).
Conclusion
ELE is prevalent in IBD, especially in CD, and associated with higher rates of mortality. Identification and management of ELE particularly when persistent are important to IBD outcomes.
We evaluated the incidence, predictors, and outcomes associated with elevated liver enzymes (ELE) in a diverse and vulnerable inflammatory bowel disease cohort. In multivariate Cox regression, ulcerative colitis (vs Crohn's disease) had a 34% lower risk of developing new ELE during follow‐up (hazard ratio 0.66, 95% confidence interval: 0.46–0.95, P = 0.02). Mortality rate was higher for patients with ELE (0% normal vs 2.3% transient ELE vs 6.5% persistent ELE, P < 0.001).