Validating the Amsterdam-Oxford Model for PSC Prognosis, with Ana Marenco Flores, MD

New research is confirming the validity of the Amsterdam-Oxford Model for predicting long-term primary sclerosing cholangitis (PSC) outcomes.1

Study findings were presented at Digestive Disease Week (DDW) 2025 by Ana Marenco Flores, MD, a research fellow in medicine in the division of gastroenterology at Beth Israel Deaconess Medical Center and Harvard Medical School, and demonstrate the Amsterdam-Oxford Model’s ability to successfully predict adverse outcomes in a US cohort of PSC patients, supporting its generalizability across diverse populations and clinical settings.1

The Amsterdam-Oxford Model, which was developed from Dutch and UK cohorts, incorporates 7 clinical variables to predict long-term PSC outcomes: PSC subtype, age at diagnosis, aspartate aminotransferase, alkaline phosphatase, total bilirubin, albumin, and platelet count.2

“[This is] a tool that can help you and the patient see what the possibilities of their outcomes are,” Marenco Flores explained to HCPLive. “You as a clinician may be able to save time and resources by doing an equation with some labs or questions and see if you have to dedicate more time to this patient… that can give you a perspective of the follow ups that you have to do with the patient or if you need to refer them to another specialist. I think doing an assessment like this in your first visit is really important to see every patient as a single case, because not all PSC patients behave the same way.”

While the model has demonstrated strong predictive accuracy, Flores and colleagues recognized the need for external validation to assess its generalizability. To do this, they analyzed data from patients with PSC enrolled in an autoimmune prospective registry between 2018 and 2024. For inclusion, patients were required to ≥ 18 years of age with confirmed PSC, complete datasets for calculating both risk scores, and ≥ 4 years of follow-up.1

Predictive performance was assessed using the area under the receiver operating characteristic curve. Investigators conducted Kaplan-Meier survival analysis, stratified by Mayo Risk Score classification and corresponding Amsterdam-Oxford Model values, to compare clinical outcomes, with survival defined as time to liver transplantation or death.1

In total, the study included 109 patients with PSC. Their mean age was 45 ± 15 years, and the majority of patients (51%) were female. Among the cohort, 85% of patients remained alive without liver transplantation (LT), 12% underwent LT, and 3% died after a median follow-up of 4.63 years.1

The median Amsterdam-Oxford Model score was 1.48 (interquartile range [IQR], 1.04 to 1.83) and the median Mayo Risk Score was -0.5 (IQR, -1.03 to -0.02). Logistic regression identified the Amsterdam-Oxford Model (odds ratio [OR], 4.95; P = .002) and low albumin (OR, 0.25; P = .027) as independent predictors of LT or death, and multivariate analysis confirmed the Amsterdam-Oxford Model’s significance (OR, 4.96; P <.001).1

Further survival analysis demonstrated worse outcomes in patients classified as high risk by both the Mayo Risk Score and Amsterdam-Oxford Model, with a 2-year survival rate of 66% compared to 92% for intermediate-risk and 95% for low-risk patients.1

“ I think for us at every clinic or hospital, your resources and time are really valuable,” Marenco Flores said. “By applying a score with data that you have at your everyday assessment of the patient, you can get a sense of personalized medicine, and that's something that we want to achieve in the future.”

Editors’ note: Marenco Flores has no relevant disclosures.

References

1. Marenco-Flores A, Amaris NR, Kahan TF, et al. EXTERNAL VALIDATION OF THE AMSTERDAM-OXFORD MODEL FOR PREDICTING LIVER TRANSPLANTATION AND MORTALITY IN U.S. PATIENTS WITH PRIMARY SCLEROSING CHOLANGITIS: A COMPARATIVE ANALYSIS WITH THE MAYO RISK SCORE. Abstract presented at Digestive Disease Week 2025 in San Diego, CA, from May 3 - May 6, 2025.

2. de Vries EM, Wang J, Williamson KD, et al. A novel prognostic model for transplant-free survival in primary sclerosing cholangitis. Gut. doi:10.1136/gutjnl-2016-313681.