Prognostic scores in primary biliary cholangitis

Abstract

Aim: Evaluating prognostic scores' utility in predicting ursodeoxycholic acid (UDCA) biochemical response (BR) and long-term liver-related complications in primary biliary cholangitis (PBC) patients. Patients & methods: This retrospective single-center study included 50 predominantly female PBC patients (median age: 56) on UDCA treatment. BR was defined by Paris II criteria. Liver-related complications during a median 76-month follow-up were assessed. APRI, ALBI, Mayo, GLOBE and UK-PBC scores were calculated. Results: 64% achieved BR, while 40% experienced liver-related complications. All scores showed good BR prediction (concordance statistics: 0.76–0.94) and excellent negative predictive values for 5-year liver complications (concordance statistics: 0.73–0.89). Conclusion: Implementing these scores in clinical practice is encouraged due to their effectiveness in predicting BR- and liver-related events.

Tweetable abstract

Prognostic scores in PBC patients on UDCA (APRI, ALBI, Mayo, GLOBE, UK-PBC), good predictors of treatment response and liver-related events. Their clinical use is encouraged. #PBC #MedicalResearch #Prognosis #UDCA.

Summary points

• Primary biliary cholangitis (PBC) is a chronic liver disease that requires reliable prognostic tools. This retrospective study of 50 PBC patients assessed prognostic scores' effectiveness in predicting biochemical response (BR) to ursodeoxycholic acid (UDCA) and liver-related complications.

• BR defined by Paris II criteria was achieved in 64%, while 40% developed liver-related complications during a 76-month follow-up.

• Non-responders to UDCA treatment had an 18-fold increase in the risk of long-term liver complications.

• APRI, ALBI, Mayo, GLOBE and UK-PBC scores showed good diagnostic performance for predicting BR (AUROC: 0.76–0.94), with GLOBE and UK-PBC demonstrating relative superiority.

• Specific cutoff points (APRI: 0.73, ALBI: -2.24, Mayo: 4.5, GLOBE: 1.26, UK-PBC: 0.0980) effectively identified UDCA treatment responders with high positive predictive values (88–96%).

• These scores also predicted 5-year liver-related events with AUROC values ranging from 0.73 to 0.89.

• Specific cutoff points (APRI: 0.93, ALBI: -2.07, Mayo: 4.5, GLOBE: 0.62, UK-PBC: 0.098) effectively ruled out PBC patients at low risk of long-term liver-related events, with negative predictive values from 89 to 100%.

• Mayo risk score demonstrated superiority in anticipating BR among pretreatment scores, and in predicting liver-related complications.

• The ALBI grades effectively stratified patients into distinct prognosis groups.

• We recommend using these prognostic scores in clinical practice to predict BR and assess the risk of liver-related events.

Keywords: :

• predictive scores
• primary biliary cholangitis
• prognosis
• treatment response
• ursodeoxycholic acid

Author contributions

R Tababi was responsible for acquisition of data, methodology, data analysis and writing the original draft. R Tababi and S Mrabet were responsible for study conception and design. S Mrabet and R Harbi and I Akkari and E Ben Jazia were responsible for conceptualization, verification and revision of the manuscript. S Mrabet and E Ben Jazia were responsible for supervision.

Financial disclosure

The authors have no financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Writing disclosure

No writing assistance was utilized in the production of this manuscript.

Competing interests disclosure

The authors have no competing interests or relevant affiliations with any organization or entity with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Ethical conduct of research

The authors state that they have obtained appropriate institutional review board approval or have followed the principles outlined in the Declaration of Helsinki for all human or animal experimental investigations.