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World J Gastroenterol. Jan 7, 2027; 33(1): 123000
Published online Jan 7, 2027. doi: 10.3748/wjg.123000
Glasgow prognostic score as a predictor of decompensation in patients with primary biliary cholangitis
Man Huang, Feng Guo, Li-Gong Bian, Chang-Hui Wu, Wen Zou, De Duan, Yuan Tang, Shun-Yu Chen, Meng-Yao Zheng, Jun-Kun Niu, Hong-Tao Lei
Man Huang, Feng Guo, Li-Gong Bian, Shun-Yu Chen, School of Public Health and Clinical Skills Training Center and School of Basic Medical Sciences, Kunming Medical University, Kunming 650500, Yunnan Province, China
Man Huang, Shangluo Vocational and Technical College, Shangluo 726000, Shaanxi Province, China
Chang-Hui Wu, Department of Infectious Diseases and Liver Diseases, Affiliated Hospital of Yunnan University, Kunming 650101, Yunnan Province, China
Wen Zou, Department of Gastroenterology, Yuxi-People’s Hospital, Yuxi 653100, Yunnan Province, China
De Duan, Department of Gastroenterology, Dali Bai Autonomous Prefecture People’s Hospital, The Third Affiliated Hospital of Dali University, Dali 671000, Yunnan Province, China
Yuan Tang, Department of Gastroenterology, Qujing City Central Hospital, Qujing 655000, Yunnan Province, China
Meng-Yao Zheng, Department of Gastroenterology, Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
Jun-Kun Niu, Department of Gastroenterology, The First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan Province, China
Hong-Tao Lei, School of Public Health, Kunming Medical University, Kunming 650500, Yunnan Province, China
Co-first authors: Man Huang and Feng Guo.
Co-corresponding authors: Meng-Yao Zheng and Hong-Tao Lei.
Author contributions: Huang M, Guo F, and Lei HT contributed to the conceptualization; Bian LG and Chen SY contributed to the methodology; Wu CH and Zou W contributed to the formal analyses; Duan D and Niu JK contributed to the data collection; Huang M and Guo F contributed to writing the original draft; Niu JK, Zheng MY, and Lei HT contributed to writing, reviewing, and editing; Huang M, Guo F, Bian LG, Wu CH, Zou W, Duan D, Tang Y, Chen SY, Zheng MY, Niu JK, and Lei HT reviewed, provided critical feedback, and approved the final version of the manuscript for publication. Huang M and Guo F contributed equally as co-first authors; Zheng MY and Lei HT contributed equally as co-corresponding authors.
AI contribution statement: No artificial intelligence (AI) tools or large language models (LLMs) were used in the conception, design, data collection, analysis, interpretation, or writing of this manuscript.
Supported by the Scientific Research Foundation of Education Department of Yunnan Province, No. 2025J0329 and No. 2025J0270; Yunnan Fundamental Research Kunming Medical University Projects, No. 202601AY070001-193 and No. 202401AY070001-311; Yunnan Provincial Postdoctoral Innovation Support Program; and Doctoral Research Project of the Second Affiliated Hospital of Kunming Medical University, No. 2025BS04.
Institutional review board statement: This retrospective study was approved by the Institutional Review Board of Kunming Medical University (approval No. KMMU2025MEC155).
Informed consent statement: The Institutional Review Board of Kunming Medical University waived the requirement for informed consent due to the retrospective nature of the study, and all patient data were anonymized.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Data sharing statement: The data that support the findings of this study are available from the corresponding author upon reasonable request, subject to institutional and ethical approval.
Corresponding author: Hong-Tao Lei, MD, Doctor, School of Public Health, Kunming Medical University, No. 1168 Chunrong West Road, Chenggong District, Kunming 650500, Yunnan Province, China.
20191209@kmmu.edu.cn
Received: May 7, 2026
Revised: June 29, 2026
Accepted: September 4, 2026
Published online: January 7, 2027
Processing time: 188 Days and 19.6 Hours
BACKGROUND
Inflammatory activity and nutritional status are closely associated with the progression of primary biliary cholangitis (PBC) and other chronic liver diseases.
AIM
To determine the predictive performance of the Glasgow prognostic score (GPS), modified GPS (mGPS), and high-sensitivity mGPS (hs-mGPS) for hepatic decompensation in PBC.
METHODS
We performed a multicenter retrospective cohort study involving patients diagnosed with compensated PBC at seven hospitals between January 2013 and December 2024. GPS, mGPS, and hs-mGPS were calculated using baseline measurements of C-reactive protein (CRP), high-sensitivity CRP, and albumin levels. The endpoint was the first occurrence of hepatic decompensation during follow-up. Time-dependent receiver operating characteristic curves (ROCs) were used to compare the predictive performance of the GPS, mGPS, hs-mGPS, Paris I, Paris II, Mayo, United Kingdom-PBC (UK-PBC), and GLOBE scores for decompensation events.
RESULTS
This analysis included 762 patients with compensated PBC. The median age was 56 years (interquartile range: 49-66), and 606 patients (79.5%) were female. Kaplan-Meier analysis showed that the 5-year decompensation rates increased progressively across higher score strata for all three indices (P < 0.0001 for all). In fully adjusted multivariate models, GPS (hazard ratio [HR] = 3.605, 95% confidence interval [CI]: 2.783-4.670), mGPS (HR = 3.103, 95%CI: 2.469-3.900), and hs-mGPS (HR = 3.261, 95%CI: 2.549-4.171) independently predicted decompensation risk (P < 0.0001 for all). Time-dependent ROC analysis indicated that the GPS score yielded the highest area under the curve (0.754) for predicting decompensation, followed by hs-mGPS (0.725), mGPS (0.696), GLOBE (0.663), UK-PBC (0.638), Mayo (0.624), Paris I (0.597), and Paris II (0.582), whereas the difference between GPS and hsmGPS was not statistically significant.
CONCLUSION
GPS, mGPS, and hs-mGPS are independent prognostic markers for decompensation in PBC. The GPS has the strongest predictive accuracy, supporting its potential clinical utility in early risk stratification and management guidance.
Core Tip: This multicenter cohort study evaluated the predictive value of the Glasgow prognostic score (GPS) and its derivatives, modified GPS (mGPS) and high-sensitivity mGPS (hs-mGPS), for hepatic decompensation in primary biliary cholangitis (PBC). GPS integrates C-reactive protein and albumin to reflect systemic inflammation and nutritional status. In 762 patients with compensated PBC, GPS, mGPS, and hs-mGPS were independent predictors of decompensation, with GPS demonstrating the highest predictive accuracy. These findings highlight GPS as a simple, cost-effective tool for early risk stratification and personalized management in PBC.
