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 - Global PBC Study Group
AU - Hansen, Bettina E.
AU - Hirschfield, Gideon M.
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.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85123807520&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/33323757
U2 - https://doi.org/10.1097/MEG.0000000000002029
DO - https://doi.org/10.1097/MEG.0000000000002029
M3 - Article
C2 - 33323757
SN - 0954-691X
VL - 33
SP - e266-e273
JO - European Journal of Gastroenterology & Hepatology
JF - European Journal of Gastroenterology & Hepatology
IS - 1S Suppl 1
ER -