Global 
Deutschland Liver and Bile
Eur J Gastroenterol Hepatol. 2022;34(4):411–6
Simplified 6-month prediction scores for primary biliary cholangitis patients treated with ursodeoxycholic acid
Objectives: To develop a prognostic score evaluating treatment response at 6 months after ursodeoxycholic acid (UDCA) initiation in primary biliary cholangitis (PBC) patients.
Methods: Adult PBC patients who were newly prescribed UDCA at the authors’ institution (n = 292) were included. Significant determinants of liver-related adverse events in the multivariable Cox model were used for score development, weighted by β-coefficients. Discrimination ability was assessed using Harrell’s C-statistic. The performance of the present model was compared to the previous models.
Results: The model included the following variables evaluated at 6 months: (1) alkaline phosphatase decline < 50% from baseline and > upper limit normal (ULN) (2 points); (2) bilirubin > ULN (2 points); (3) albumin < lower limit normal (1 point). The score ranged from 0 to 5 points. C-statistic estimates were 0.87 (overall cohort), 0.87 (no cirrhosis) and 0.77 (cirrhosis), indicating good discrimination of treatment response. Patients with scores ≥ 3 points had significant shorter transplant-free survival (TFS) than scores < 3 points (p < 0.001). The TFS rates for patients with score ≥ 3 points at 5, 10 and 15 years were 52%, 26% and 7%, and for patients with scores < 3 points were 96%, 92% and 82%, respectively. There was no significant difference between the performance of the 6-month model and the previous models (Paris I, Paris II, Barcelona, Rotterdam and GLOBE scores evaluated at 12 months) in predicting liver-related outcomes (all p = n.s.).
Conclusion: This novel 6-month prognostic model showed good prognostic performance. Utilization of this score would identify patients with suboptimal responses to ursodeoxycholic acid earlier.