The Mayo Clinic Score for Primary Sclerosing Cholangitis (PSC) Calculator is a clinical tool used to predict the prognosis and survival of patients with primary sclerosing cholangitis, a chronic liver disease characterized by progressive inflammation and scarring of the bile ducts. This score helps healthcare providers estimate the likelihood of disease progression and mortality, guiding clinical management decisions, including the timing of liver transplantation evaluation. It provides an objective assessment of disease severity and helps identify patients who may benefit from closer monitoring or more aggressive interventions.
The Mayo Clinic Score for PSC is calculated using a combination of clinical and laboratory variables that reflect liver dysfunction and overall health status. The key factors included in the calculation are:
- Age: Older age is associated with a worse prognosis in PSC patients.
- Serum Bilirubin: Elevated bilirubin levels indicate impaired liver function and are a strong predictor of disease severity and progression.
- Serum Albumin: Lower serum albumin levels reflect reduced liver synthetic function, suggesting more advanced disease.
- Aspartate Aminotransferase (AST): Higher AST levels indicate liver inflammation or damage, contributing to the overall risk assessment.
- History of Variceal Bleeding: The presence of variceal bleeding, a complication of portal hypertension, signifies advanced liver disease and increases the risk of poor outcomes.
The formula for calculating the Mayo Clinic Score for PSC is:
PSC Risk Score = (0.03 × Age) + (0.54 × ln(Bilirubin)) – (0.84 × Albumin) + (0.54 × ln(AST)) + (1.24 × Variceal Bleeding Indicator)
Where:
- Age is the patient’s age in years.
- Bilirubin is measured in mg/dL.
- Albumin is measured in g/dL.
- AST is measured in U/L.
- Variceal Bleeding Indicator is 1 if the patient has a history of variceal bleeding and 0 if not.
To use the Mayo Clinic Score for PSC Calculator, healthcare providers input the patient’s age, serum bilirubin, albumin, AST levels, and information about variceal bleeding history. The calculator then computes the PSC risk score, which correlates with the estimated survival probability and disease progression risk over a defined period, typically up to four years.
Interpreting the Mayo Clinic Score for PSC helps guide clinical decision-making. A higher score indicates a greater risk of disease progression and mortality, suggesting the need for more intensive management, frequent monitoring, and potentially early referral for liver transplantation evaluation. Lower scores suggest a more stable disease state with a better short-term prognosis, allowing for routine management and follow-up.
This score is particularly useful in making informed decisions about patient care, such as prioritizing patients for liver transplantation, which is the definitive treatment for advanced PSC. It also assists in counseling patients and their families about the expected course of the disease and planning for future healthcare needs.
