# 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.

## Key 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.