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Murillo Perez CF, Gulamhusein A, Carbone M, et al. Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool. Eur J Gastroenterol Hepatol. 2020;doi: 10.1097/MEG.0000000000002029.
Murillo Perez, C. F., Gulamhusein, A., Carbone, M., Trivedi, P. J., van der Meer, A. J., Corpechot, C., Battezzati, P. M., Lammers, W. J., Cazzagon, N., Floreani, A., Parés, A., Nevens, F., Lleo, A., Mayo, M. J., Kowdley, K. V., Ponsioen, C. Y., Dalekos, G. N., Gatselis, N. K., Thorburn, D., Mason, A. L., Janssen, H., Verhelst, X., Bruns, T., Lindor, K. D., Chazouillères, O., Invernizzi, P., Hansen, B. E., Hirschfield, G. M. (2020). Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool. European journal of gastroenterology & hepatology, . https://doi.org/10.1097/MEG.0000000000002029
Murillo Perez, Carla F, et al. "Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool." European journal of gastroenterology & hepatology vol. (2020). doi: https://doi.org/10.1097/MEG.0000000000002029
Murillo Perez CF, Gulamhusein A, Carbone M, Trivedi PJ, van der Meer AJ, Corpechot C, Battezzati PM, Lammers WJ, Cazzagon N, Floreani A, Parés A, Nevens F, Lleo A, Mayo MJ, Kowdley KV, Ponsioen CY, Dalekos GN, Gatselis NK, Thorburn D, Mason AL, Janssen H, Verhelst X, Bruns T, Lindor KD, Chazouillères O, Invernizzi P, Hansen BE, Hirschfield GM. Simplified care-pathway selection for nonspecialist practice: the GLOBAL Primary Biliary Cholangitis Study Group Age, Bilirubin, Alkaline phosphatase risk assessment tool. Eur J Gastroenterol Hepatol. 2020 Dec 14; doi: 10.1097/MEG.0000000000002029. Epub 2020 Dec 14. PMID: 33323757.
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Eur J Gastroenterol Hepatol. 2020 Dec 14; doi: 10.1097/MEG.0000000000002029. Epub 2020 Dec 14.

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

European journal of gastroenterology & hepatology

Carla F Murillo Perez, Aliya Gulamhusein, Marco Carbone, Palak J Trivedi, Adriaan J van der Meer, Christophe Corpechot, Pier Maria Battezzati, Willem J Lammers, Nora Cazzagon, Annarosa Floreani, Albert Parés, Frederik Nevens, Ana Lleo, Marlyn J Mayo, Kris V Kowdley, Cyriel Y Ponsioen, George N Dalekos, Nikolaos K Gatselis, Douglas Thorburn, Andrew L Mason, Harry Janssen, Xavier Verhelst, Tony Bruns, Keith D Lindor, Olivier Chazouillères, Pietro Invernizzi, Bettina E Hansen, Gideon M Hirschfield,

Affiliations

  1. Toronto Centre for Liver Disease, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
  2. Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.
  3. Division of Gastroenterology and Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
  4. European Reference Network on Hepatological Diseases (ERN RARE-LIVER).
  5. National Institute for Health Research Birmingham Biomedical Research Centre and Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
  6. Reference Center for Inflammatory Biliary Diseases and Autoimmune Hepatitis, Saint-Antoine Hospital, APHP, Sorbonne University, Paris, France.
  7. Department of Health Sciences, Universita[Combining Grave Accent] degli Studi di Milano, Milan.
  8. Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy.
  9. Liver Unit, Hospital Cli[Combining Acute Accent]nic, CIBERehd, IDIBAPS, University of Barcelona, Barcelona, Spain.
  10. Department of Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium.
  11. Division of Internal Medicine and Hepatology, Humanitas Clinical Research Center IRCSS, Humanitas University, Rozzano, Milan, Italy.
  12. Digestive and Liver Diseases Clinic, UT Southwestern Medical Center, Dallas, Texas.
  13. Liver Care Network and Organ Care Research, Swedish Medical Center, Seattle, Washington, USA.
  14. Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, the Netherlands.
  15. Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece.
  16. The Sheila Sherlock Liver Centre, The Royal Free Hospital, London, UK.
  17. Divison of Gastroenterology and Hepatology, University of Alberta, Edmonton, Alberta, Canada.
  18. Department of Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium.
  19. Department of Internal Medicine IV, Jena University Hospital, Friedrich Schiller University, Jena, Department of Internal Medicine III, University Hospital RWTH Aachen, Aachen, Germany.
  20. College of Health Solutions, Arizona State University, Phoenix, Arizona, USA.
  21. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.

PMID: 33323757 DOI: 10.1097/MEG.0000000000002029

Abstract

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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