A new bile acid liver disease complication (BALDC) model could help predict the prognosis of complications such as ascites in early-stage liver disease, for which patients with alpha-1 antitrypsin deficiency (AATD) are at an increased risk, according to a new study published in the International Journal of Hepatology.

The researchers assessed prognostic biomarkers based on the urinary bile acid profiles of 257 patients with cholestatic liver diseases.

“In this study, we have examined the ability of [bile acid] indices to predict complications in patients with liver diseases,” the researchers explained. “Logistic regression model was used to predict the prognosis of hepatobiliary diseases in terms of developing disease-related complications.”

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The researchers’ BALDC model confirmed that the accumulation of primary bile acid and reductions in secondary bile acid in the blood could signal disordered bile flow, a significant indicator of liver disease. They found that the likelihood of developing ascites increased as a function of the scores obtained in the BALDC, mixed bile acid, and non-bile acid models.

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The authors employed receiver operating characteristic curve analyses to compare the models’ accuracies in predicting ascites and other complications of liver disease, and they found all the models to have high levels of accuracy in terms of ascites.

In addition to ascites, the research team attempted a similar model-development approach to predict other complications of liver disease, including encephalopathy, hepatobiliary carcinoma, bacterial peritonitis, portal hypertension, and hepatorenal syndrome. However, none of them were predicted as accurately as ascites when using the BALDC and non-bile acid models.

The ability to predict the development of ascites at the early stages of liver disease in patients with AATD and related disease conditions could significantly impact clinicians’ decisions regarding treatment and transplantation for these patients.


Li W, Alamoudi JA, Gautam N, et al. Urinary BA indices as prognostic biomarkers for complications associated with liver diseases. Int J Hepatol. 2022;2022:5473752. doi:10.1155/2022/5473752