PRIMARY BILIARY-CIRRHOSIS - PREDICTION OF SHORT-TERM SURVIVAL BASED ON REPEATED PATIENT VISITS

The progression of primary biliary cirrhosis was studied in 312 patien ts who were seen at the Mayo Clinic between January 1974 and May 1984. Follow-up was extended to April 30, 1988, by which time 140 of the pa tients had died and 29 had undergone orthotopic liver transplantation. These patients generated 1,945 patient visits that enabled us to stud y the change in the prognostic variables of primary biliary cirrhosis (age, bilirubin value, albumin value, prothrombin time and edema) from the time of referral. Also, using this database and the Cox proportio nal-hazards regression model, we developed an updated model for primar y biliary cirrhosis that can be used to predict short-term survival at any time in the course of the disease. This model uses the values of the prognostic variables measured at the latest patient visit. Compari son of predicted survival from the update model and the natural histor y model of primary biliary cirrhosis showed that the updated model was superior to the original model for predicting short-term survival. Th is finding applied to both the Mayo Clinic patients and an independent set of 83 Dutch patients. The Mayo updated model is recommended for i mproving the accuracy of predictions of survival during the 2 yr after a patient visit.