Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver · 2026
Internal validation of the Hepascore and Liver Outcome Score for predicting clinical outcomes in autoimmune hepatitis and primary sclerosing cholangitis: a multi-centre study.
СтатьяМногоцентровое исследованиеВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Jayabalan Dujinthan, Calzadilla-Bertot Luis, Huang Yi, Cheng Wendy, Hazeldine Simon, Smith Briohny W, MacQuillan Gerry C, Wallace Michael C, Garas George, Adams Leon A, Jeffrey Gary P
Аннотация
BACKGROUND/AIMS: We aimed to internally validate the predictive performance of Liver Outcome Score (LOS) and Hepascore for clinical outcomes (overall death or transplant, liver-related mortality, and decompensation) in autoimmune hepatitis (AIH) and primary sclerosing cholangitis (PSC).
METHODS: AIH and PSC patients from the Hepascore and Clinical Outcome cohort were included, excluding overlap syndromes. Outcomes were extracted via data linkage. LOS and Hepascore were evaluated for discrimination, calibration, internal validation using bootstrapped multivariable Cox regression and competing-risk analysis.
RESULTS: This study included 237 AIH patients (24% male, median-age 56.6 years) and 167 PSC patients (53% male, median-age 55.6 years). LOS was validated as a predictor of overall death or transplant, but not liver-related mortality or decompensation, in AIH (5-year tAUC=0.78, HR 1.28, p=0.011) and PSC (5-year tAUC=0.77, HR 1.20, p=0.007). Hepascore was validated as a predictor of overall death or transplant (5-year tAUC=0.81, HR 8.63, p=0.009), liver-related mortality (5-year tAUC=0.79, HR 60, p=0.046) and decompensation (5-year tAUC=0.76, HR 5.62, p=0.018). In AIH, LOS ≥5.9 worsened 5-year transplant-free survival (74.4% vs 94.3%, p=0.0021) and in PSC, Hepascore ≥0.84 identified high-risk patients across all endpoints (p<0.0001). Competing-risk regression confirmed these associations accounting for non-liver-related deaths.
CONCLUSION: LOS and Hepascore are internally validated predictors of clinical outcomes in AIH and PSC.
METHODS: AIH and PSC patients from the Hepascore and Clinical Outcome cohort were included, excluding overlap syndromes. Outcomes were extracted via data linkage. LOS and Hepascore were evaluated for discrimination, calibration, internal validation using bootstrapped multivariable Cox regression and competing-risk analysis.
RESULTS: This study included 237 AIH patients (24% male, median-age 56.6 years) and 167 PSC patients (53% male, median-age 55.6 years). LOS was validated as a predictor of overall death or transplant, but not liver-related mortality or decompensation, in AIH (5-year tAUC=0.78, HR 1.28, p=0.011) and PSC (5-year tAUC=0.77, HR 1.20, p=0.007). Hepascore was validated as a predictor of overall death or transplant (5-year tAUC=0.81, HR 8.63, p=0.009), liver-related mortality (5-year tAUC=0.79, HR 60, p=0.046) and decompensation (5-year tAUC=0.76, HR 5.62, p=0.018). In AIH, LOS ≥5.9 worsened 5-year transplant-free survival (74.4% vs 94.3%, p=0.0021) and in PSC, Hepascore ≥0.84 identified high-risk patients across all endpoints (p<0.0001). Competing-risk regression confirmed these associations accounting for non-liver-related deaths.
CONCLUSION: LOS and Hepascore are internally validated predictors of clinical outcomes in AIH and PSC.