Factors Associated With Outcomes of Patients With Primary Sclerosing Cholangitis and Development and Validation of a Risk Scoring System.
Goode EC., Clark AB., Mells GM., Srivastava B., Spiess K., Gelson WTH., Trivedi PJ., Lynch KD., Castren E., Vesterhus MN., Karlsen TH., Ji SG., Anderson CA., Thorburn D., Hudson M., M H., Aldersley MA., Bathgate A., Sandford RN., Alexander GJ., Chapman RW., Walmsley M., UK-PSC Consortium None., Hirschfield GM., Rushbrook SM.
BACKGROUND & AIMS: We sought to identify factors predictive of liver transplantation or death in patients with Primary Sclerosing Cholangitis (PSC), and to develop and validate a contemporaneous risk score for use in a real-world clinical setting. METHODS: Analysing data from 1001 patients recruited to the UK-PSC research cohort, we evaluated clinical variables for their association with 2- and 10-year outcome through Cox-proportional hazards and C-statistic analyses. We generated risk scores for short- and long-term outcome prediction, validating their use in two independent cohorts totalling 451 patients. RESULTS: 36% of the derivation cohort were transplanted or died over a cumulative follow-up of 7,904 years. Serum alkaline phosphatase ≥2.4×ULN at 1 year post diagnosis, was predictive of 10-year outcome (HR=3.05, C=0.63, median transplant-free survival 63 versus 108 months, p<0.0001), as was the presence of extra-hepatic biliary disease (HR=1.45, p=0.01). We developed two risk scoring systems based upon age, values of bilirubin, alkaline phosphatase, albumin, platelets, presence of extra-hepatic biliary disease and variceal haemorrhage, which predicted 2- and 10-year outcome with good discrimination (C=0.81 and 0.80 respectively). Both UK-PSC risk scores were well-validated in our external cohort, and out-performed the Mayo and APRI scores (C=0.75 and 0.63 respectively). Whilst heterozygosity for the previously validated HLA-DR*03:01 risk allele predicted increased risk of adverse outcome (HR=1.33, p=.001), its addition did not improve the predictive accuracy the UK-PSC risk scores. CONCLUSIONS: Our analyses, based upon a detailed clinical evaluation of a large representative cohort of participants with PSC, furthers our understanding of clinical risk markers and reports the development and validation of a real-world scoring system to identify those patients most likely to die or require liver transplantation. This article is protected by copyright. All rights reserved.