Researchers call for ICP to be included in hepatobiliary risk stratification

Rebecca Lissmann (Queen Mary University of London, UK), who presented the findings, said: “We think that inclusion of ICP in hepatobiliary risk stratification should be considered, and through the life course history of ICP should be taken into account when considering the risk and decisions to investigate a possible hepatic biliary disease.”

The researchers also found that the risk was greatest for Black women compared with those of other ethnicities, raising the need for interventions to “be assigned equitably to tackle health inequalities between ethnic groups.”

Lissmann and colleagues collated routinely collected data from primary and secondary care databases in the UK on 3,701,995 women, with a mean age of 29 years, who had a first pregnancy and no prior history of hepatobiliary disease.

Of these, 31,082 had ICP, at an incidence of 0.8%. Across ethnicities, the incidence ranged from 0.5% in Black women to 1.3% in South-Asian women.

Over a median follow-up of 10.4 years between 2000 and 2021, women with ICP were significantly more likely to develop hepatobiliary morbidity, comprising composite hepatobiliary disease, gallstone disease, pancreatitis, infectious hepatobiliary disease, fibrosis and cirrhosis, hepatobiliary malignancy, end-stage liver disease, and other hepatobiliary disease.

Specifically, the rate for composite hepatobiliary disease was 8.5% compared with 5.7% among women without ICP. This equated to a significant adjusted hazard ratio (aHR) of 2.38.

ICP was also associated with significantly increased risks for all the other hepatobiliary diseases, with aHRs ranging from 2.05 for end-stage liver disease to 2.92 for fibrosis and cirrhosis. There was a significant aHR of 4.05 for hepatobiliary malignancy, but Lissmann points out that the number of women in this group was small.

The increased risk for composite hepatobiliary morbidity was consistent across most ethnicities, but particularly high for Black women with ICP whose rate of composite hepatobiliary disease was 10.4%, giving a significant HR compared with women without ICP of 3.02.

Lissmann reported that the difference in risk for composite hepatobiliary disease among women with versus those without ICP became evident very soon after birth. And the absolute 20-year risk in women with ICP in a first pregnancy was 17.2% versus 10.8% for those without ICP, with a significant difference of 6.4 percentage points.

The presenter highlighted that given the women were 29 years old on average at the time they had ICP, at 20 years of follow-up, “there won’t have been enough time for some of the more severe diseases to have developed yet.”