Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool

被引：0

作者：

Perez, Carla F. Murillo ^{[1
,2
]}

Gulamhusein, Aliya ^{[1
]}

Carbone, Marco ^{[3
,4
,5
]}

Trivedi, Palak J. ^{[6
,7
]}

van der Meer, Adriaan J. ^{[2
]}

Corpechot, Christophe ^{[8
]}

Battezzati, Pier Maria ^{[9
]}

Lammers, Willem J. ^{[2
]}

Cazzagon, Nora ^{[10
]}

Floreani, Annarosa ^{[5
,10
]}

Pares, Albert ^{[11
]}

Nevens, Frederik ^{[12
]}

Lleo, Ana ^{[13
]}

Mayo, Marlyn J. ^{[14
]}

Kowdley, Kris V. ^{[15
]}

Ponsioen, Cyriel Y. ^{[16
]}

Dalekos, George N. ^{[17
]}

Gatselis, Nikolaos K. ^{[17
]}

Thorburn, Douglas ^{[18
]}

Mason, Andrew L. ^{[19
]}

Janssen, Harry ^{[1
]}

Verhelst, Xavier ^{[4
,5
,20
,21
,22
]}

Bruns, Tony

Lindor, Keith D. ^{[23
]}

Chazouilleres, Olivier ^{[8
]}

Invernizzi, Pietro ^{[3
,4
,5
]}

Hansen, Bettina E. ^{[1
,24
]}

Hirschfield, Gideon M. ^{[1
]}

机构：

[1] Univ Hlth Network, Toronto Gen Hosp, Toronto Ctr Liver Dis, Toronto, ON, Canada

[2] Erasmus MC, Gastroenterol & Hepatol, Rotterdam, Netherlands

[3] Univ Milano Bicocca, San Gerardo Hosp, Div Gastroenterol, Monza, Italy

[4] Univ Milano Bicocca, San Gerardo Hosp, Ctr Autoimmune Liver Dis, Dept Med & Surg, Monza, Italy

[5] European Reference Network Hepatol Dis ERN RARE, Paris, France

[6] Univ Birmingham, Natl Inst Hlth Res, Birmingham Biomed Res Ctr, Birmingham, W Midlands, England

[7] Univ Birmingham, Ctr Liver & Gastrointestinal Res, Inst Immunol & Immunotherapy, Birmingham, W Midlands, England

[8] Sorbonne Univ, St Antoine Hosp, AP HP, Reference Ctr Inflammatory Biliary Dis & Autoimmu, Paris, France

[9] Univ Milan, Dept Hlth Sci, Milan, Italy

[10] Univ Padua, Dept Surg Oncol & Gastroenterol, Padua, Italy

[11] Univ Barcelona, Hosp Clin, Liver Unit, CIBERehd, Barcelona, Spain

[12] Katholieke Univ Leuven, Univ Hosp Leuven, Dept Hepatol, Leuven, Belgium

[13] Humanitas Univ, Humanitas Clin Res Ctr IRCSS, Div Internal Med & Hepatol, Milan, Italy

[14] UT SouthWestern Med Ctr, Digest & Liver Dis Clin, Dallas, TX USA

[15] Swedish Med Ctr, Liver Care Network & Organ Care Res, Seattle, WA USA

[16] Acad Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[17] Gen Univ Hosp Larissa, Natl Expertise Ctr Greece Autoimmune Liver Dis, Dept Med & Res Lab Internal Med, Larisa, Greece

[18] Royal Free Hosp, Sheila Sherlock Liver Ctr, London, England

[19] Univ Alberta, Div Gastroenterol & Hepatol, Edmonton, AB, Canada

[20] Ghent Univ Hosp, Dept Gastroenterol & Hepatol, Ghent, Belgium

[21] Friedrich Schiller Univ, Jena Univ Hosp, Dept Internal Med 4, Jena, Germany

[22] Univ Hosp RWTH, Dept Internal Med 3, Aachen, Germany

[23] Arizona State Univ, Coll Hlth Solut, Phoenix, AZ USA

[24] Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

来源：

EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY | 2021年 / 33卷

关键词：

autoimmune liver disease; cholestatic liver disease; liver function tests; primary biliary cholangitis; PLACEBO-CONTROLLED TRIAL; BIOCHEMICAL RESPONSE; CIRRHOSIS; PROGNOSIS; PROGRESSION; ACID;

D O I：

10.1097/MEG.0000000000002029

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

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 x ULN, alkaline phosphatase (ALP) <= 3 x ULN], high (Age <= 50 years, bilirubin > 1 x ULN, ALP > 3 x 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. Copyright (C) 2020 Wolters Kluwer Health, Inc. All rights reserved.

引用

页码：E266 / E273

页数：8

共 1 条

[1] Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool
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
Pares, 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.
Chazouilleres, Olivier
Invernizzi, Pietro
Hansen, Bettina E.
Hirschfield, Gideon M.
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, 2021, 33 (1S) : E266 - E273

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