{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T13:36:53Z","timestamp":1783690613467,"version":"3.55.0"},"reference-count":53,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Primary biliary cholangitis (PBC) is a chronic, immune\u2010mediated liver disease that can lead to fibrosis and cirrhosis. In this cohort study, we aimed to investigate morbidity and mortality in conjunction with metabolomic changes of PBC in a UK population\u2010based cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>454 participants with PBC and 908 propensity score (age, sex, BMI, ethnicity) matched controls without liver disease were included in the study. A subset of participants with PBC and controls were analysed for their metabolomic profile. Further, PBC\u2010associated comorbidities were investigated by PheWAS analysis. Lastly, we assessed causes of death in individuals with PBC using a Fine and Grey competing\u2010risks regression model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to the control group, various pathways associated with the metabolism of amino acids, lipids, and liver biochemistry were significantly enriched in individuals with PBC. We found reduced levels of S\u2010HDL\u2010cholesterol and Glycoprotein Acetyls in individuals with PBC as well as an association with diseases of the circulatory system. Notably, PBC individuals had a higher prevalence of digestive diseases, autoimmune diseases, cardiovascular diseases, anaemias, mental disorders, and urinary tract infections compared to the control group. Strikingly, the overall mortality was almost three times higher in the PBC group compared to the control group, with diseases of the digestive system accounting for a significant elevation of the death rate. A subsequent analysis, enhanced by propensity score matching that included the APRI score, demonstrated that the observed morbidity could not be exclusively attributed to advanced hepatic disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our study provides a detailed perspective on the morbidity of individuals with PBC. The exploration of potential effects of disease state on morbidity suggest that early detection and early treatment of PBC could enhance patient prognosis and prevent the onset of comorbid diseases. Finally, the metabolomic alterations could represent a link between the pathophysiological processes underlying PBC development, progression, and associated morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/liv.15945","type":"journal-article","created":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T08:40:06Z","timestamp":1714034406000},"page":"2038-2053","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Comorbidities, mortality and metabolic profile in individuals with primary biliary cholangitis\u2014A Phenome\u2010Wide\u2010Association\u2010Study"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2846-703X","authenticated-orcid":false,"given":"Paul\u2010Henry","family":"Koop","sequence":"first","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Constanze","family":"Schwenzer","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2925-8438","authenticated-orcid":false,"given":"Jan","family":"Clusmann","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3211-7823","authenticated-orcid":false,"given":"Mara S.","family":"Vell","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1122-5331","authenticated-orcid":false,"given":"Julius","family":"Jaeger","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenfang","family":"Gui","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2762-8247","authenticated-orcid":false,"given":"Christian","family":"Trautwein","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Koch","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5576-6914","authenticated-orcid":false,"given":"Tony","family":"Bruns","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6728-9246","authenticated-orcid":false,"given":"Carolin V.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"},{"name":"The Institute for Translational Medicine and Therapeutics, The Perelman School of Medicine University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0047-3794","authenticated-orcid":false,"given":"Kai Markus","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine III, Gastroenterology, Metabolic Diseases and Intensive Care University Hospital RWTH Aachen  Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1750-1172-3-1"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/ajg.2017.440"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41575-019-0226-7"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29675"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000002291"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/HEP.0000000000000506"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v12.i45.7250"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2009.11.027"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fct.2018.07.022"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2009.01.003"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.12680"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1053\/jhep.2003.50346"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2014.01.029"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12021-021-09553-4"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC48229.2022.9871333"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/sim.9023"},{"key":"e_1_2_10_18_1","volume-title":"Statisticians of the Centuries","author":"Bonferroni C","year":"1936"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41592-019-0686-2"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/jamiaopen\/ooy012"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1109\/MCSE.2007.55"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.21105\/joss.03021"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.121.024380"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-47890-2"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23210"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.3748\/wjg.v28.i39.5764"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aohep.2019.07.006"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12876-021-01974-4"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1871"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/flgastro-2018-101124"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12967-017-1321-6"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.12452"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0033442"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1152\/ajpgi.00501.2009"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2016.04.005"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.1840150518"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2017.03.022"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.2008.02092.x"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-230X-11-95"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.32172"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.32074\/1591-951X-245"},{"key":"e_1_2_10_42_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1016\/S0025-6196(25)18890-3","article-title":"Autoimmune associations in primary biliary cirrhosis","volume":"57","author":"Culp KS","year":"1982","journal-title":"Mayo Clin Proc"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0034-1383734"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/PL00009532"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.4254\/wjh.v14.i2.319"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinre.2019.05.002"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1093\/jcag\/gwz039"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhepr.2023.100688"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-014-8446-7"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-014-8427-x"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.14321"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.3350\/cmh.2020.0028"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.14309\/ctg.0000000000000615"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-023-04464-z"}],"container-title":["Liver International"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.15945","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/liv.15945","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/liv.15945","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,8]],"date-time":"2026-03-08T19:05:53Z","timestamp":1772996753000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/liv.15945"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":53,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2024,8]]}},"alternative-id":["10.1111\/liv.15945"],"URL":"https:\/\/doi.org\/10.1111\/liv.15945","archive":["Portico"],"relation":{},"ISSN":["1478-3223","1478-3231"],"issn-type":[{"value":"1478-3223","type":"print"},{"value":"1478-3231","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]},"assertion":[{"value":"2023-10-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-25","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}