TY - JOUR
T1 - Simplified care-pathway selection for nonspecialist practice
T2 - The GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool
AU - Murillo Perez, Carla F.
AU - Gulamhusein, Aliya
AU - Carbone, Marco
AU - Trivedi, Palak J.
AU - Van Der Meer, Adriaan J.
AU - Corpechot, Christophe
AU - Battezzati, Pier Maria
AU - Lammers, Willem J.
AU - Cazzagon, Nora
AU - Floreani, Annarosa
AU - Parés, Albert
AU - Nevens, Frederik
AU - Lleo, Ana
AU - Mayo, Marlyn J.
AU - Kowdley, Kris V.
AU - Ponsioen, Cyriel Y.
AU - Dalekos, George N.
AU - Gatselis, Nikolaos K.
AU - Thorburn, Douglas
AU - Mason, Andrew L.
AU - Janssen, Harry
AU - Verhelst, Xavier
AU - Bruns, Tony
AU - Lindor, Keith D.
AU - Chazouillères, Olivier
AU - Invernizzi, Pietro
AU - Hansen, Bettina E.
AU - Hirschfield, Gideon M.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - 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.
AB - 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.
KW - autoimmune liver disease
KW - cholestatic liver disease
KW - liver function tests
KW - primary biliary cholangitis
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U2 - 10.1097/MEG.0000000000002029
DO - 10.1097/MEG.0000000000002029
M3 - Article
C2 - 33323757
AN - SCOPUS:85123807520
SN - 0954-691X
VL - 33
SP - E266-E273
JO - European Journal of Gastroenterology and Hepatology
JF - European Journal of Gastroenterology and Hepatology
IS - 1
ER -