Glasgow prognostic score as a predictor of decompensation in patients with primary biliary cholangitis

Table 1 Scoring criteria for the Glasgow prognostic score, modified Glasgow prognostic score, high-sensitivity modified Glasgow prognostic score

Score	GPS	mGPS	hs-mGPS
0	CRP ≤ 10 mg/L and ALB ≥ 35 g/L	CRP ≤ 10 mg/L	hs-CRP ≤ 3 mg/L
1	CRP > 10 mg/L or ALB < 35 g/L	CRP > 10 mg/L and ALB ≥ 35 g/L	hs-CRP > 3 mg/L and ALB ≥ 35 g/L
2	CRP > 10 mg/L and ALB < 35 g/L	CRP > 10 mg/L and ALB < 35 g/L	hs-CRP > 3 mg/L and ALB < 35 g/L

Unlike the modified Glasgow prognostic score (mGPS), high-sensitivity modified Glasgow prognostic score (hs-mGPS), which evaluates albumin (ALB) only when C-reactive protein (CRP)/high-sensitivity CRP (hs-CRP) is elevated, the original Glasgow prognostic score (GPS) scores albumin independently of CRP. GPS: Glasgow prognostic score; mGPS: Modified Glasgow prognostic score; hs-mGPS: High-sensitivity modified Glasgow prognostic score; CRP: C-reactive protein; ALB: Albumin.

Table 2 Comparison of baseline clinical characteristics, n (%)/median interquartile range

Characteristic	Total (n = 762)	Decompensation (n = 113)	Non-decompensation (n = 649)	P value
Age (years)	56 (49-66)	57 (50-70.5)	56 (49-65)	0.112
Sex				0.973
Female	606 (79.5)	90 (79.6)	516 (79.5)
Male	156 (20.5)	23 (20.4)	133 (20.5)
BMI (kg/m2)	22.06 (20.02-24.22)	21.50 (19.95-23.90)	22.06 (20.04-24.38)	0.222
Hypertension				0.974
Yes	183 (24)	27 (23.9)	156 (24)
No	579 (76)	86 (76.1)	493 (76)
Diabetes mellitus				0.898
Yes	85 (11.2)	13 (11.5)	72 (11.1)
No	677 (88.8)	100 (88.5)	577 (88.9)
Atherosclerosis				0.990
Yes	47 (6.2)	7 (6.2)	40 (6.2)
No	715 (93.8)	106 (93.8)	609 (93.8)
TBIL (μmol/L)	18.4 (12.4-40.08)	27.1 (12.65-80.6)	17.8 (12.35-35)	0.002
ALT (U/L)	53.5 (28-106)	63 (29.1-111.5)	52 (28-104)	0.249
AST (U/L)	54 (33-103.93)	75 (37.85-119)	50 (32-98.95)	0.002
ALP (U/L)	176.15 (113-320)	252 (139.75-440.5)	171 (108.5-285)	< 0.001
GGT (U/L)	205 (71-415.75)	253 (104-521.5)	196 (68-404.5)	0.011
INR	1 (0.94-1.09)	1.01 (0.91-1.13)	1 (0.94-1.09)	0.737
GLOB (g/L)	33.15 (29-37.6)	32.5 (28.5-39.05)	33.2 (29-37.5)	0.829
ALB (g/L)	37.9 (33.5-42)	34 (29.5-38.4)	38.4 (34.2-42.2)	< 0.001
CRP (mg/L)	2.47 (1.1-7.35)	10.8 (3.63-12.75)	1.97 (1.02-5)	< 0.001
MELD score	3.86 (1.53-7.34)	5.57 (2.16-9.13)	3.67 (1.48-6.79)	0.007
AMA-M2				0.877
1	528 (69.3)	79 (69.9)	449 (69.2)
0	234 (30.7)	34 (30.1)	200 (30.8)
SP100				0.623
1	84 (11.1)	14 (12.4)	70 (10.8)
0	676 (88.9)	99 (87.6)	577 (89.2)
GP210				0.361
1	164 (21.5)	28 (24.8)	136 (21)
0	598 (78.5)	85 (75.2)	513 (79)
Paris I				0.001
Response	495 (65)	58 (51.3)	437 (67.3)
Suboptimal response	267 (35)	55 (48.7)	212 (32.7)
Paris II				0.011
Response	319 (41.9)	35 (31)	284 (43.8)
Suboptimal response	443 (58.1)	78 (69)	365 (56.2)
Mayo	4 (3-5)	5 (4-6)	4 (3-5)	< 0.001
GLOBE				< 0.001
> 0.3	133 (17.5)	37 (32.7)	96 (14.8)
≤ 0.3	629 (82.5)	76 (67.3)	553 (85.2)
UK-PBC	0.57 (-0.32 to 1.98)	1.49 (0.26-3.10)	0.46 (-0.40 to 1.77)	< 0.001
GPS				< 0.001
0	475 (62.3)	26 (23.0)	449 (69.2)
1	198 (26.0)	49 (43.4)	149 (23.0)
2	89 (11.7)	38 (33.6)	51 (7.8)
mGPS				< 0.001
0	616 (80.8)	51 (45.1)	565 (87.1)
1	58 (7.6)	24 (21.3)	34 (5.2)
2	88 (11.6)	38 (33.6)	50 (7.7)
hs-mGPS				< 0.001
0	445 (58.4)	27 (23.9)	418 (64.4)
1	166 (21.8)	36 (31.9)	130 (20.0)
2	151 (19.8)	50 (44.2)	101 (15.6)

ALB: Albumin; ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AMA-M2: Anti-mitochondrial antibody M2; AST: Aspartate aminotransferase; BMI: Body mass index; CRP: C-reactive protein; GGT: Gamma-glutamyl transferase; GLOB: Globulin; GP210: Anti-glycoprotein 210 antibody; GPS: Glasgow prognostic score; hs-mGPS: High-sensitivity modified Glasgow prognostic score; INR: International normalized ratio; MELD: Model for end-stage liver disease; mGPS: Modified Glasgow prognostic score; SP100: Anti-nuclear dot protein SP100 antibody; TBIL: Total bilirubin; UK-PBC: United Kingdom-primary biliary cholangitis.

Table 3 Univariable and multivariable Cox regression analyses of the association between Glasgow prognostic scores and decompensation risk

Variable	Univariate analysis		Multivariate analysis
			Model A		Model B		Model C
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
GPS
0	Reference		Reference		Reference		Reference
1	5.593 (3.475-9.003)	< 0.001	5.805 (3.589-9.389)	< 0.001	5.911 (3.647-9.580)	< 0.001	5.540 (3.346-9.173)	< 0.001
2	14.289 (8.617-23.694)	< 0.001	13.618 (8.133-22.804)	< 0.001	13.942 (8.290-23.450)	< 0.001	13.573 (7.835-23.514)	< 0.001
P for trend	3.690 (2.922-4.660)	< 0.001	3.595 (2.837-4.556)	< 0.001	3.654 (2.875-4.643)	< 0.001	3.605 (2.783-4.670)	< 0.001
mGPS
0	Reference		Reference		Reference		Reference
1	7.747 (4.755-12.62)	< 0.001	8.512 (5.169-14.016)	< 0.001	8.537 (5.180-14.070)	< 0.001	8.025 (4.805-13.405)	< 0.001
2	10.09 (6.546-15.551)	< 0.001	9.219 (5.926-14.340)	< 0.001	9.511 (6.082-14.873)	< 0.001	8.459 (5.211-13.732)	< 0.001
P for trend	3.238 (2.644-3.965)	< 0.001	3.128 (2.544-3.846)	< 0.001	3.188 (2.584-3.932)	< 0.001	3.103 (2.469-3.900)	< 0.001
hs-mGPS
0	Reference		Reference		Reference		Reference
1	7.161 (4.291-11.952)	< 0.001	7.315 (4.349-12.305)	< 0.001	7.307 (4.322-12.353)	< 0.001	7.343 (4.269-12.630)	< 0.001
2	12.224 (7.523-19.862)	< 0.001	11.951 (7.257-19.679)	< 0.001	12.187 (7.382-20.120)	< 0.001	11.407 (6.669-19.511)	< 0.001
P for trend	3.283 (2.639-4.084)	< 0.001	3.245 (2.591-4.064)	< 0.001	3.300 (2.628-4.143)	< 0.001	3.261 (2.549-4.171)	< 0.001

Model A: Adjusted for age, sex, body mass index. Model B: Adjusted for all variables in model A plus hypertension, diabetes mellitus, and atherosclerosis. Model C: Adjusted for all variables in model B plus total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, international normalized ratio, anti-mitochondrial antibody M2, anti-nuclear dot protein SP100 antibody, and anti-glycoprotein 210 antibody. Total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and international normalized ratio were treated as continuous variables, whereas anti-mitochondrial antibody M2, anti-nuclear dot protein SP100 antibody, and anti-glycoprotein 210 antibody were treated as categorical variables. CI: Confidence interval; GPS: Glasgow prognostic score; HR: Hazard ratio; hs-mGPS: High-sensitivity modified Glasgow prognostic score; mGPS: Modified Glasgow prognostic score.

Table 4 Association between Glasgow prognostic scores and decompensation risk, stratified by model for end-stage liver disease score

Variable	Univariate analysis		Multivariate analysis
			Model A		Model B		Model C
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
MELD ≥ 10
GPS	3.173 (2.142-4.698)	< 0.001	3.024 (2.017-4.534)	< 0.001	3.072 (2.041-4.623)	< 0.001	3.521 (2.215-5.597)	< 0.001
mGPS	2.683 (2.000-3.599)	< 0.001	2.592 (1.909-3.519)	< 0.001	2.629 (1.933-3.577)	< 0.001	3.014 (2.113-4.299)	< 0.001
hs-mGPS	2.205 (1.584-3.069)	< 0.001	2.115 (1.499-2.984)	< 0.001	2.096 (1.485-2.959)	< 0.001	2.207 (1.509-3.226)	< 0.001
MELD < 10
GPS	3.598 (2.618-4.943)	< 0.001	3.484 (2.519-4.817)	< 0.001	3.673 (2.648-5.094)	< 0.001	3.982 (2.768-5.729)	< 0.001
mGPS	3.266 (2.407-4.431)	< 0.001	3.101 (2.278-4.221)	< 0.001	3.217 (2.345-4.413)	< 0.001	3.685 (2.569-5.288)	< 0.001
hs-mGPS	3.937 (2.909-5.328)	< 0.001	3.846 (2.821-5.244)	< 0.001	4.132 (2.997-5.697)	< 0.001	4.347 (3.069-6.159)	< 0.001

CI: Confidence interval; GPS: Glasgow prognostic score; HR: Hazard ratio; hs-mGPS: High-sensitivity modified Glasgow prognostic score; MELD: Model for end-stage liver disease; mGPS: Modified Glasgow prognostic score.

Table 5 Association between Glasgow prognostic scores and decompensation risk in the sensitivity analysis after excluding patients with hypertension, atherosclerosis, or diabetes mellitus

Variable	Univariate analysis		Multivariate analysis
			Model A		Model B
	HR (95%CI)	P value	HR (95%CI)	P value	HR (95%CI)	P value
GPS	4.306 (3.230-5.740)	< 0.001	4.341 (3.246-5.805)	< 0.001	4.265 (3.118-5.834)	< 0.001
mGPS	3.602 (2.827-4.589)	< 0.001	3.547 (2.776-4.534)	< 0.001	3.400 (2.605-4.437)	< 0.001
hs-mGPS	3.464 (2.676-4.483)	< 0.001	3.463 (2.661-4.506)	< 0.001	3.423 (2.580-4.541)	< 0.001

Model A: Adjusted for age, sex, body mass index. Model B: Adjusted for all variables in model A plus total bilirubin, alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase, international normalized ratio, anti-mitochondrial antibody M2, anti-nuclear dot protein SP100 antibody, and anti-glycoprotein 210 antibody. CI: Confidence interval; GPS: Glasgow prognostic score; HR: Hazard ratio; hs-mGPS: High-sensitivity modified Glasgow prognostic score; mGPS: Modified Glasgow prognostic score.