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.
- prognostic factor
- risk score
- autoimmune liver disease
- Norwich Medical School - Associate Professor
- Population Health - Member
- Epidemiology and Public Health - Member
- Health Services and Primary Care - Member
- Norwich Clinical Trials Unit - Member
Person: Research Group Member, Research Centre Member, Academic, Teaching & Research