Retrospective Cohort Study
Copyright ©The Author(s) 2018.
World J Clin Cases. Apr 16, 2018; 6(4): 44-53
Published online Apr 16, 2018. doi: 10.12998/wjcc.v6.i4.44
Table 1 Clinical characteristics of patients1n (%)
TBA > 8TBA < 8P value
(n = 96)(n = 1246)
Age (mean ± SD, yr)44 ± 1.641.5 ± 0.40.118
Male60 (63)639 (51)0.027
Female35 (36)603 (48)
CD47 (49)716 (57)0.267
UC45 (47)498 (40)
IC3 (3)26 (2)
Disease duration (mean ± SD, yr)11 ± 1.29.8 ± 0.30.446
CDAI (mean ± SD)92.8 ± 8.782.1 ± 2.70.316
MTWI (mean ± SD)3.6 ± 0.64.1 ± 0.20.436
Smokers16 (17)339 (27)0.023
Non smokers80 (83)903 (72)
Extra intestinal manifestations
Arthritis21 (22)362 (2)0.133
Uveitis4 (4)68 (5)0.588
Pyoderma gangrenosum1 (1)12 (1)0.938
Erythema nodosum4 (4)42 (3)0.679
Oral soars5 (5)70 (6)0.867
Spondylarthritis3 (3)52 (4)0.617
Primary sclerosing cholangitis5 (5)10 (1)0.000
Colorectal cancer0 (0)5 (0)0.533
Colonic dysplasia1 (1)5 (0)0.364
Lymphoma0 (0)0 (0)Ns
Osteoporosis17 (18)184 (15)0.436
Anemia11 (11)229 (18)0.088
Thrombosis5 (5)20 (2)0.011
Gallstone5 (5)33 (3)0.145
Urinary stones2 (2)38 (3)0.591
Malabsorption5 (5)38 (3)0.247
Lab values
TBA (mean ± SD, μmol/L)21.9 ± 5.53.1 ± 0.11.36 × 10-30
CRP (mean ± SD, mg/L)9.8 ± 1.611.7 ± 0.70.460
Ferritine (mean ± SD, μg/L)158.5 ± 39.9239.2 ± 35.90.516
B12 vitamin (mean ± SD, pmol/L)604.1 ± 155.9446.8 ± 27.10.130
Alkaline phosphatase (mean ± SD, U/L)108.1 ± 10.869.7 ± 1.210.00 × 10-13
Albumin (mean ± SD, g/L)38.0 ± 0.839.8 ± 0.20.016
Medical therapies
Oral 5-ASA39 (41)415 (33)0.147
Topical 5-ASA9 (9)114 (9)0.855
Sulfasalazine0 (0)28 (2)Ns
Metronidazole1 (1)31 (2)0.723
Ciprofloxacine4 (4)28 (2)0.281
Clarithromycine0 (0)1 (0)Ns
Cyclosporine0 (0)12 (1)Ns
Tacrolimus3 (3)8 (1)0.009
Azathioprine38 (40)407 (33)0.177
6-Mercaptopurine5 (5)67 (5)Ns
Remicade9 (9)183 (15)0.174
Humira1 (1)51 (4)0.172
Cimzia0 (0)19 (2)Ns
Methotrexate5 (5)79 (6)0.827
Budesonide9 (9)107 (9)0.708
Systemic prednisone20 (21)170 (14)0.051
Topical prednisone2 (2)28 (2)0.716
Ursodesoxycholic acid10 (10)7 (1)2.84 × 10-8
Cholestiramine2 (2)24 (2)0.708
Supplements
Iron12 (13)188 (15)0.492
Vitamin B1213 (14)191 (15)0.638
Folate8 (8)125 (10)0.591
Multivitamin2 (2)76 (6)0.105
Magnesium6 (6)54 (4)0.381
Calcium37 (39)356 (29)0.038
Vitamin D28 (29)270 (22)0.088
Vitamin E3 (3)9 (1)0.016
Potassium1 (1)16 (1)Ns
Lactase0 (0)3 (0)Ns
Pancreatic enzymes0 (0)6 (0)Ns
Fishoil4 (4)37 (3)0.511
Enteric nutrition0 (0)6 (0)Ns
Parenteric nutrition1 (1)3 (0)0.165
Probiotics3 (3)16 (1)0.141
1Results expressed in number with percentage in parenthesis otherwise stated. Clinical characteristics of patients with elevated or normal total bile acid level. SD: Standard deviation; CD: Crohn’s disease; UC: Ulcerative colitis; IC: Indeterminate colitis; CDA: Crohn’s disease activity index; MTWI: Modified Truelove and Witts index; TBA: Total bile acid; CRP: C-reactive protein.
Table 2 Univariate analysis1n (%)
TBA > 8TBA < 8P value
(n = 80)(n = 1190)
TBA (mean ± SD, μmol/L)14.66 ± 1.243.07 ± 0.066.15 × 10-144
Alkaline phosphatase (mean ± SD, U/L)81 ± 5.8169.3 ± 1.250.021
Albumin (mean ± SD, g/L)38.0 ± 0.9239.9 ± 0.210.017
Vitamin D25 (31)254 (21)0.038
Vitamin E2 (3)9 (1)0.103
Calcium30 (38)336 (28)0.076
Prednisone16 (20)160 (13)0.100
Azathioprine37 (46)383 (32)0.009
Smokers12 (15)330 (28)0.012
Thrombosis4 (5)17 (1)0.015
1Results expressed in number with percentage in parenthesis otherwise stated. Univariate analysis of factors differentiating patients with or without cholestasis. TBA: Total bile acid; SD: Standard deviation.
Table 3 Multivariate analysis
ORCIP value
Gender1.480.83-2.670.188
Alkaline phosphatase1.000.99-1.010.282
Albumin0.960.92-1.010.108
Current smoking status0.420.17-0.910.041
Azathioprine treatment1.570.873-2.790.128
Prednisone treatment1.150.53-2.360.707
Vitamin D supplement0.720.29-1.790.471
Vitamin E supplement4.360.56-24.460.110
Calcium supplement2.361.00-5.210.040
Thrombosis1.380.19-5.890.701
Multivariate analysis of factors associated with a cholestasis comparing 80 patients with cholestasis and 1190 patients without cholestasis. CRP: C-reactive protein; OR: Odd-ratio; CI: Confidence interval.
Table 4 Bile acids subtypes
TBA > 8 (80)TBA < 8 (80)P value
TBA14.64 (1.24)3.31 (0.22)1.07 × 10-15
Primary
CA1.09 (0.29)0.29 (0.04)0.008
Cholic acid
CDC chenodeoxycholate2.06 (0.41)0.68 (0.13)0.002
Secondary
DC1.35 (0.27)0.28 (0.04)0.000
deoxycholate
LCA0.07 (0.01)0.07 (0.01)0.9
lithocholic acid
Tertiary
UDC0.34 (0.05)0.14 (0.03)0.000
ursodeoxycholate
Primary conjugated
TC0.37 (0.08)0.04 (0.01)0.000
taurocholate
GCA1.78 (0.28)0.38 (0.05)1.83 × 10-6
gylcocholate acid
TCDC0.74 (0.11)0.18 (0.02)1.58 × 10-6
taurochenodeoxycholate
GCDC4.72 (0.33)1.42 (0.12)1.54 × 10-16
glycochenodeoxycholate
Secondary conjugated
GDC1.01 (0.10)0.30 (0.04)1.38 × 10-9
glycodeoxycholate
TDC0.20 (0.03)0.05 (0.01)8.78 × 10-7
taurodeoxycholate
TLC0.04 (0.01)0.01 (0.00)8.46 × 10-5
taurolithocholate
GLC0.09 (0.01)0.09 (0.01)0.646
glycolithocholate
Tertiary conjugated
TUDC0.06 (0.01)0.001 (0.00)1.69 × 10-8
tauroursodeoxycholate
GUDC0.84 (0.12)0.19 (0.03)4.58 × 10-7
glycoursodeoxycholate
Hydroxydes
DHCA0.004 (0.002)0.001 (0.001)0.291
dihydroxycholestanoic acid
THCA0.001 (0.001)0.000 (0.000)0.275
trihydroxycholestanoic acid
Ratio
Primary/secondary3.48 (0.92)4.42 (1.34)0.566
Primary/TBA0.23 (0.05)0.31 (0.04)0.211
Conjugated glycine/taurine
Primary11.64 (1.18)10.70 (0.89)0.537
Secondary6.40 (0.61)5.15 (0.66)0.209
Bile acids subtypes expressed in μmol/L with standard deviation under bracket, in 80 patients with a total bile acids level of more than 8 μmol/L compared with 80 patients with a total bile acids level of less than 8 μmol/L. TBA: Total bile acids; CA: Cholic acid; CDC: Chenodeoxycholate; DC: Deoxycholate; LCA: Lithocholic acid; UDC: Ursodeoxycholate; TC: Taurocholate; GCA: Gylcocholate acid; TCDC: Taurochenodeoxycholate; GCDC: Glycochenodeoxycholate; TDC: Taurodeoxycholate; GDC: Glycodeoxycholate; TLC: Taurolithocholate; GLC: Glycolithocholate; TUDC: Tauroursodeoxycholate; GUDC: Glycoursodeoxycholate; DHCA: Dihydroxycholestanoic acid; THCA: Trihydroxycholestanoic acid.