Which patients with palliative malignant biliary obstruction will benefit most from biliary drainage: Development and validation of a prognostic score

TL;DR

This study developed a prognostic score to predict 30-day mortality in patients with palliative malignant biliary obstruction after biliary drainage.

Contribution

A new prognostic score was developed and validated to identify patients likely to benefit from biliary drainage in palliative care.

Findings

The score includes factors like performance status, bilirubin levels, and metastases to predict 30-day mortality.

The score showed good discrimination in the derivation cohort with an AUROC of 0.86.

In the validation cohort, the score effectively separated low- and high-risk patients with 30-day mortality rates of 7% and 22%.

Abstract

Biliary drainage is performed in palliative malignant biliary obstruction (MBO) to improve patient quality of life and enable chemotherapy. This study aimed to create and validate a prognostic score after biliary drainage in patients with palliative MBO.

Patients undergoing endoscopic or percutaneous drainage for palliative MBO were included in a multicenter, retrospective study. Probability factors associated with 30-day mortality were evaluated by univariable and multivariable logistic regression in the derivation cohort and a prognostic score was built and evaluated in an independent validation cohort.

The derivation cohort included 262 patients, 55% male, 61% of whom had pancreatic adenocarcinoma, mean age 72 years. Probability factors associated with 30-day mortality identified in the derivation cohort were World Health Organization performance status of 3–4 (odds ratio [OR] 7.7 [2.57–25.0] ; +3 points), liver metastases (OR 2.7 [1.06–6.98] ; +1 point), other metastases (OR 3.85 [1.57–9.97] ; +2 points), leukocytes >12G/l (OR 2.4 [0.94–6.08]; +1 point), total bilirubin > 10.8 mg/dL (OR 4.3 [1.45–15.20] ; +2 points) and creatininemia > 5.0 mg/dL (OR 7.3 [2.89–19.86]; +3 points). The multivariable model showed good discrimination, with an area under the receiver operating curve (AUROC) of 0.86 (95% confidence interval 0.80–0.93). The prognostic score was used to define two groups of patients, with a low (0–4 points) or high-probability (> 4 points) of 30-day mortality (3% and 32%, respectively). The AUROC in the validation cohort (192 patients) was 0.72, with 30-day mortality of 7% in the low- probability group and 22% in the high- probability group (
P
= 0.02).

This score could be used in routine clinical practice to identify patients who have better survival outcomes after biliary drainage in palliative MBO.

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