Glasgow Prognostic Score Predicts Hepatic Recompensation in Decompensated Primary Biliary Cholangitis: A Multicenter Cohort Study.

BACKGROUND

Chronic liver disease progression is closely linked to systemic inflammatory responses and nutritional status. This study aimed to evaluate the prognostic value of the Glasgow Prognostic Score (GPS) system for predicting recompensation in patients with decompensated primary biliary cholangitis (PBC).

METHODS

This multicenter, retrospective cohort study enrolled patients with decompensated PBC admitted to seven hospitals between January 2014 and December 2023. The GPS, mGPS, and hs-mGPS were determined according to baseline CRP, hs-CRP, and ALB levels. The primary endpoint was the achievement of recompensation during follow-up (defined as biochemical response to UDCA, resolution of decompensating events, and stable improvement in liver function per Baveno VII criteria).

RESULTS

Of the 504 patients with decompensated PBC analyzed, the median age was 62 years (IQR: 53-69) and 81.5% (n=411) were women. Over a median follow-up of 31 months (IQR: 14-56), recompensation occurred in 136 patients (27.0%). Kaplan-Meier analysis confirmed that higher GPS, mGPS, and hs-mGPS scores were associated with lower 5-year recompensation rates (all P < 0.0001). Cox regression analysis revealed that in the fully adjusted model, GPS (HR: 0.311, 95% CI: 0.219-0.444), mGPS (HR: 0.302, 95% CI: 0.188-0.487), and hs-mGPS (HR: 0.351, 95% CI: 0.248-0.496) were all independent predictors for recompensation. Time-dependent ROC analysis showed that the AUCs for predicting recompensation were 0.888 for GPS, 0.795 for mGPS, and 0.871 for hs-mGPS, indicating the best predictive performance for GPS. Sensitivity and subgroup analyses confirmed the robustness of these findings.

CONCLUSION

The GPS and its variants reliably predict recompensation in decompensated PBC, with the GPS showing superior accuracy. These tools can stratify risk and inform early intervention strategies.