Original ArticleA Revised Natural History Model for Primary Sclerosing Cholangitis
Section snippets
Patients
Table 2 describes the 2 sources of data used in this work. The first data were the existing data used in the multicenter model. These data were derived from patients at John Radcliffe Hospital, Oxford, England; King's College, London, England; New England Medical Center, Boston, Mass; Thomas Jefferson University, Philadelphia, Pa; and Mayo Clinic, Rochester, Minn. The second data were generated from a recent randomized trial conducted at Mayo Clinic in which ursodeoxycholic acid was evaluated
Results
In the univariate analysis, the following variables had a significant (P<.01) influence on patient survival (Table 3): age; presence of ascites, hepatomegaly, splenomegaly, and variceal bleeding; hemoglobin level, platelet count, and prothrombin time; and the serum levels of aspartate aminotransferase (AST), albumin, and total bilirubin. Serum alkaline phosphatase level (P=.04), presence of inflammatory bowel disease (P=.16), and male sex (P=.08) showed marginal significance, and presence of
Discussion
Natural history models in PBC and PSC have been used as clinical and research tools.10, 11, 12 In comparison with the PBC model, our previous PSC model has not been widely used. One of the obstacles may have been that the model requires a liver biopsy to assess histologic stage, a notable drawback in application of the model.13 Second, previous models contained variables that were subjective in nature. For example, variables such as splenomegaly or inflammatory bowel disease may be defined
Acknowledgments
We thank Drs Roger W. Chapman (John Radcliffe Hospital, Oxford, England), Marshall M. Kaplan (New England Medical Center, Boston, Mass), Willis Maddrey (Texas Southwestern University, Dallas), and Roger Williams (King's College, London, England) for generously providing data that made this analysis possible.
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This study was supported by grant DK34238 from the National Institutes of Health, Bethesda, Md.