{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:34:54Z","timestamp":1793921694825,"version":"4.8.0"},"reference-count":39,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T00:00:00Z","timestamp":1545955200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2018,12,28]],"date-time":"2018-12-28T00:00:00Z","timestamp":1545955200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["RO1 DK 084960"],"award-info":[{"award-number":["RO1 DK 084960"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["RC2 DK 118619"],"award-info":[{"award-number":["RC2 DK 118619"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Catharine Nicole Jockisch Carlos Endowment in PSC","id":[{"id":"https:\/\/ror.org\/0229evh14","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:p>\n                    Improved methods are needed to risk stratify and predict outcomes in patients with primary sclerosing cholangitis (PSC). Therefore, we sought to derive and validate a prediction model and compare its performance to existing surrogate markers. The model was derived using 509 subjects from a multicenter North American cohort and validated in an international multicenter cohort (n = 278). Gradient boosting, a machine\u2010based learning technique, was used to create the model. The endpoint was hepatic decompensation (ascites, variceal hemorrhage, or encephalopathy). Subjects with advanced PSC or cholangiocarcinoma (CCA) at baseline were excluded. The PSC risk estimate tool (PREsTo) consists of nine variables: bilirubin, albumin, serum alkaline phosphatase (SAP) times the upper limit of normal (ULN), platelets, aspartate aminotransferase (AST), hemoglobin, sodium, patient age, and number of years since PSC was diagnosed. Validation in an independent cohort confirms that PREsTo accurately predicts decompensation (C\u2010statistic, 0.90; 95% confidence interval [CI], 0.84\u20100.95) and performed well compared to Model for End\u2010Stage Liver Disease (MELD) score (C\u2010statistic, 0.72; 95% CI, 0.57\u20100.84), Mayo PSC risk score (C\u2010statistic, 0.85; 95% CI, 0.77\u20100.92), and SAP &lt;1.5 \u00d7 ULN (C\u2010statistic, 0.65; 95% CI, 0.55\u20100.73). PREsTo continued to be accurate among individuals with a bilirubin &lt;2.0 mg\/dL (C\u2010statistic, 0.90; 95% CI, 0.82\u20100.96) and when the score was reapplied at a later course in the disease (C\u2010statistic, 0.82; 95% CI, 0.64\u20100.95).\n                    <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic>\n                    PREsTo accurately predicts hepatic decompensation (HD) in PSC and exceeds the performance among other widely available, noninvasive prognostic scoring systems.\n                  <\/jats:p>","DOI":"10.1002\/hep.30085","type":"journal-article","created":{"date-parts":[[2018,5,9]],"date-time":"2018-05-09T19:50:22Z","timestamp":1525895422000},"page":"214-224","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":143,"title":["Primary Sclerosing Cholangitis Risk Estimate Tool (PREsTo) Predicts Outcomes of the Disease: A Derivation and Validation Study Using Machine Learning"],"prefix":"10.1097","volume":"71","author":[{"given":"John E.","family":"Eaton","sequence":"first","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mette","family":"Vesterhus","sequence":"additional","affiliation":[{"name":"Norwegian PSC Research Center,Division of Surgery, Inflammatory Medicine and Transplantation,Oslo University Hospital,Rikshospitalet,Oslo,Norway"},{"name":"National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital,Bergen,Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan M.","family":"McCauley","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth J.","family":"Atkinson","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics and Informatics,Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik M.","family":"Schlicht","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Juran","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea A.","family":"Gossard","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas F.","family":"LaRusso","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J.","family":"Gores","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom H.","family":"Karlsen","sequence":"additional","affiliation":[{"name":"Norwegian PSC Research Center,Division of Surgery, Inflammatory Medicine and Transplantation,Oslo University Hospital,Rikshospitalet,Oslo,Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos N.","family":"Lazaridis","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology &,Hepatology Mayo Clinic,Rochester,MN"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,12,28]]},"reference":[{"key":"hep30085-bib-0001-20241017","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1053\/j.gastro.2013.06.052","article-title":"Pathogenesis of primary sclerosing cholangitis and advances in diagnosis and 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