{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T11:24:39Z","timestamp":1788780279289,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,1,7]],"date-time":"2022-01-07T00:00:00Z","timestamp":1641513600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Liver International"],"published-print":{"date-parts":[[2022,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background &amp; Aims<\/jats:title><jats:p>Machine learning (ML) provides new approaches for prognostication through the identification of novel subgroups of patients. We explored whether ML could support disease sub\u2010phenotyping and risk stratification in primary biliary cholangitis (PBC).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>ML was applied to an international dataset of PBC patients. The dataset was split into a derivation cohort (training set) and a validation cohort (validation set), and key clinical features were analysed. The outcome was a composite of liver\u2010related death or liver transplantation. ML and standard survival analysis were performed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The training set was composed of 11,819 subjects, while the validation set was composed of 1,069 subjects. ML identified four clusters of patients characterized by different phenotypes and long\u2010term prognosis. Cluster 1 (n\u00a0=\u00a03566) included patients with excellent prognosis, whereas Cluster 2 (n\u00a0=\u00a03966) consisted of individuals at worse prognosis differing from Cluster 1 only for albumin levels around the limit of normal. Cluster 3 (n\u00a0=\u00a02379) included young patients with florid cholestasis and Cluster 4 (n\u00a0=\u00a01908) comprised advanced cases. Further sub\u2010analyses on the dynamics of albumin within the normal range revealed that ursodeoxycholic acid\u2010induced increase of albumin &gt;1.2 x lower limit of normal (LLN) is associated with improved transplant\u2010free survival.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Unsupervised ML identified four novel groups of PBC patients with different phenotypes and prognosis and highlighted subtle variations of albumin within the normal range. Therapy\u2010induced increase of albumin &gt;1.2 x LLN should be considered a treatment goal.<\/jats:p><\/jats:sec>","DOI":"10.1111\/liv.15141","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T15:28:23Z","timestamp":1640359703000},"page":"615-627","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Machine learning in primary biliary cholangitis: A novel approach for risk stratification"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5086-0514","authenticated-orcid":false,"given":"Alessio","family":"Gerussi","sequence":"first","affiliation":[{"name":"Division of Gastroenterology Center for Autoimmune Liver Diseases Department of Medicine and Surgery University of Milano\u2010Bicocca Monza Italy"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) San Gerardo Hospital Monza 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H\u00f4pital Saint\u2010 Antoine APHP\u2010Sorbonne Universit\u00e9 Paris France"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) H\u00f4pital Saint\u2010Antoine Paris France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Cazzagon","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua Padua Italy"},{"name":"European Reference Network on Hepatological Diseases (ERN RARE\u2010LIVER) Azienda Ospedale \u2010 Universit\u00e0 Padova Padova Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annarosa","family":"Floreani","sequence":"additional","affiliation":[{"name":"Department of Surgery, Oncology and Gastroenterology University of Padua Padua Italy"},{"name":"Scientific Institute for Research Hospitalization and Healthcare Verona 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