Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool.
European journal of gastroenterology & hepatology
BACKGROUND: 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.
Swedish Digestive Health Institute
Murillo Perez, Carla F; Gulamhusein, Aliya; Carbone, Marco; Trivedi, Palak J; van der Meer, Adriaan J; Corpechot, Christophe; Battezzati, Pier Maria; Lammers, Willem J; Cazzagon, Nora; Floreani, Annarosa; Parés, Albert; Nevens, Frederik; Lleo, Ana; Mayo, Marlyn J; Kowdley, Kris V; Ponsioen, Cyriel Y; Dalekos, George N; Gatselis, Nikolaos K; Thorburn, Douglas; Mason, Andrew L; Janssen, Harry; Verhelst, Xavier; Bruns, Tony; Lindor, Keith D; Chazouillères, Olivier; Invernizzi, Pietro; Hansen, Bettina E; Hirschfield, Gideon M; and GLOBAL PBC Study Group, "Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool." (2020). Articles, Abstracts, and Reports. 4236.