In:
European Journal of Gastroenterology & Hepatology, Ovid Technologies (Wolters Kluwer Health), Vol. 33, No. 1S ( 2021-12), p. e266-e273
Abstract:
Opportunity to redefine the care journeys for those living with primary biliary cholangitis (PBC) includes facilitating access to enhanced (PBC-dedicated) programmes by nonspecialist risk ‘flagging’ of patients. Objective To develop a nonexpert PBC stratification tool to help care pathway choices (standard vs. enhanced) choices in PBC. Methods We included ursodeoxycholic acid-treated patients with PBC from the Global PBC Study Group. The performance of baseline and 1-year clinical markers with transplant-free survival was assessed to develop the ‘ABA’ tool using Age (A), Bilirubin (B), and Alkaline phosphatase (A). Added value of fibrosis estimation was assessed. Results ‘ABA’ classification mapped three risk groups ( n = 2226): low [Age 〉 50 years, bilirubin ≤ 1 × ULN, alkaline phosphatase (ALP) ≤ 3 × ULN], high (Age ≤ 50 years, bilirubin 〉 1 × ULN, ALP 〉 3 × ULN), and intermediate (other). Transplant-free survival at 10 years in the low-, intermediate-, and high-risk groups were 89, 77, and 59% at baseline and 86, 76, and 40% at 1 year, respectively. We propose that high-risk patients at baseline be directly triaged to enhanced (PBC-dedicated) care and the remaining be reassessed at 1 year. Modelling showed after 1 year 46% patients were proposed to enhanced care and 54% to standard care. The ‘ABA’ mapped pathways facilitated identification of patients at risk based on a young age, as compared to traditional liver biochemical stratification. In patients proposed to standard care, estimated fibrosis stage had ongoing prognostic value. Conclusion Nonspecialist use of the ‘ABA’ risk tool could prioritize care journey choices for patients with PBC.
Type of Medium:
Online Resource
ISSN:
0954-691X
DOI:
10.1097/MEG.0000000000002029
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2021
detail.hit.zdb_id:
2030291-5
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