Observational Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2023; 15(8): 1774-1783
Published online Aug 27, 2023. doi: 10.4240/wjgs.v15.i8.1774
Prognostic scores in primary biliary cholangitis patients with advanced disease
Juan Feng, Jia-Min Xu, Hai-Yan Fu, Nan Xie, Wei-Min Bao, Ying-Mei Tang
Juan Feng, Jia-Min Xu, Hai-Yan Fu, Nan Xie, Ying-Mei Tang, Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, Kunming 650101, Yunnan Province, China
Wei-Min Bao, Department of General Surgery, Yunnan Provincial First People’s Hospital, Kunming 650032, Yunnan Province, China
Author contributions: Feng J, Xu JM, Bao WM, and Tang YM designed the research study; Feng J, Xu JM, Fu HY, and Xie N performed the research; All authors contributed to data collection and collation; Feng J and Xu JM analyzed the data and wrote the manuscript; All authors read and approved the final manuscript.
Supported by Medicine Leading Talents of Yunnan Province, No. L-2019013; the Yunnan Wanren Project, No. YNWR-MY-2018-028; and Clinical Research Project of the Second Affiliated Hospital of Kunming Medical University, No. 2020ynlc010.
Institutional review board statement: The Ethics Committee of the second affiliated hospital of Kunming medical university approved the study (Approval No. YJ-2022-14), the protocol was approved by each participating center.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: Not applicable.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ying-Mei Tang, PhD, Teacher, Department of Gastroenterology, The Second Affiliated Hospital of Kunming Medical University, No. 374 Dianmian Road, Wuhua District, Kunming 650101, Yunnan Province, China. tangyingmei_med@kmmu.edu.cn
Received: March 23, 2023
Peer-review started: March 23, 2023
First decision: April 26, 2023
Revised: May 9, 2023
Accepted: May 30, 2023
Article in press: May 30, 2023
Published online: August 27, 2023
Abstract
BACKGROUND

Due to the chronic progressive disease characteristics of primary biliary cholangitis (PBC), patients with advanced PBC should not be ignored. Most prognostic score studies have focused on early stage PBC.

AIM

To compare the prognostic value of various risk scores in advanced PBC to help PBC patients obtain more monitoring and assessment.

METHODS

This study considered patients diagnosed with PBC during hospitalization between 2015 and 2021. The clinical stage was primarily middle and late, and patients usually took ursodeoxycholic acid (UDCA) after diagnosis. The discriminatory performance of the scores was assessed with concordance statistics at baseline and after 1 year of UDCA treatment. Telephone follow-up was conducted to analyze the course and disease-associated outcomes. The follow-up deadline was December 31, 2021. We compared the risk score indexes between those patients who reached a composite end point of death or liver transplantation (LT) and those who remained alive at the deadline. The combined performance of prognostic scores in estimating the risk of death or LT after 1 year of UDCA treatment was assessed using Cox regression analyses. Predictive accuracy was evaluated by comparing predicted and actual survival through Kaplan-Meier analyses.

RESULTS

We included 397 patients who were first diagnosed with PBC during hospitalization and received UDCA treatment; most disease stages were advanced. After an average of 6.4 ± 1.4 years of follow-up, 82 patients had died, and 4 patients had undergone LT. After receiving UDCA treatment for 1 year, the score with the best discrimination performance was the Mayo, with a concordance statistic of 0.740 (95% confidence interval: 0.690-0.791). The albumin-bilirubin, GLOBE, and Mayo scores tended to overestimate transplant-free survival. Comparing 7 years of calibration results showed that the Mayo score was the best model.

CONCLUSION

The Mayo, GLOBE, UK-PBC, and ALBI scores demonstrated comparable discriminating performance for advanced stage PBC. The Mayo score showed optimal discriminatory performance and excellent predictive accuracy.

Keywords: Primary biliary cholangitis, Prognostic value, Liver transplantation, Cholangitis, Mayo score

Core Tip: Primary biliary cholangitis (PBC) is a chronic progressive liver disease that destroys the intrahepatic small bile ducts. PBC in the middle and late stages cannot be ignored. The present study enrolled patients first diagnosed with PBC during hospitalization whose disease stages were primarily in the middle and late stages. We compared the prognostic value of various risk scores in PBC patients with advanced disease stages so that a significant proportion would undergo monitoring, disease evaluation, and timely treatment.