Systematic review: non-invasive prognostic tests for primary sclerosing cholangitis

Area of Science:

• Hepatology
• Gastroenterology
• Medical Diagnostics

Background:

• Primary sclerosing cholangitis (PSC) is a chronic liver disease requiring prognostic assessment.
• Various prognostic tests, including biochemical models, elastography, and imaging scores, have been developed for PSC.

Purpose of the Study:

• To systematically review non-invasive prognostic tests for primary sclerosing cholangitis (PSC).

Main Methods:

• A systematic review of studies published between 1987 and 2020 was conducted.
• Included studies assessed blood tests, biochemical models, elastography, and imaging scores for PSC outcomes.
• 26 studies involving 13,759 PSC patients were included in the analysis of non-invasive tests.

Main Results:

• Alkaline phosphatase normalization correlated with transplant-free survival and reduced cancer risk, but cut-offs varied.
• The Mayo Risk Score (MRS) was the most studied biochemical model (c-statistic 0.63-0.85).
• UK-PSC score (c-statistic 0.81) outperformed MRS (0.75), transient elastography (>11.1 kPa) indicated survival risks, and Anali score predicted complications. Promising models include ELF and PREsTo.

Conclusions:

• The Mayo Risk Score (MRS) is the most studied prognostic score for PSC clinical outcomes.
• UK-PSC score and PREsTo demonstrate superior test performance compared to MRS.
• Further comparative studies of MRS against UK-PSC, PREsTo, ELF, and imaging-based scores are necessary.