Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age,
Carla F Murillo Perez1,2, Aliya Gulamhusein1, Marco Carbone3,4
1Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Insights
A new risk stratification tool, ABA (Age, Bilirubin, Alkaline phosphatase), helps identify primary biliary cholangitis (PBC) patients needing enhanced care. This tool enables non-specialists to better guide PBC patient care pathways.
Area of Science:
- Hepatology
- Clinical Medicine
- Patient Stratification
Background:
- Primary biliary cholangitis (PBC) care pathways can be improved by identifying patients who would benefit from enhanced, specialized programs.
- Nonspecialist flagging of at-risk patients is key to redefining PBC care journeys.
Purpose of the Study:
- To develop a nonexpert tool for stratifying patients with primary biliary cholangitis (PBC).
- To aid in determining appropriate care pathway choices (standard vs. enhanced) for PBC patients.
Main Methods:
- Utilized data from ursodeoxycholic acid-treated PBC patients in the Global PBC Study Group.
- Developed the 'ABA' tool using Age, Bilirubin, and Alkaline phosphatase (ALP) levels.
- Assessed the prognostic performance of baseline and 1-year clinical markers for transplant-free survival.
Main Results:
- The 'ABA' tool classified 2226 patients into low, intermediate, and high-risk groups.
- 10-year transplant-free survival varied significantly by risk group (89% low, 77% intermediate, 59% high at baseline).
- At 1 year, high-risk patients showed a marked decrease in survival (40%), suggesting a need for early intervention.
Conclusions:
- The 'ABA' tool, incorporating age, bilirubin, and ALP, effectively stratifies PBC patients for risk-based care.
- High-risk patients identified at baseline should be directly referred to enhanced care programs.
- The ABA tool facilitates risk identification, particularly in younger patients, compared to traditional methods.
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.
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