Primary Sclerosing Cholangitis Worsens Prognosis in Patients With Inflammatory Bowel Disease: A Propensity-Matched Cohort Study

Background: Few data are available on the impact of primary sclerosing cholangitis (PSC) on inflammatory bowel disease (IBD). Objective: We conducted a retrospective study using TriNetX to compare the outcomes of patients with IBD and those with concomitant IBD and PSC. Methods: All patients with a confirmed diagnosis of Crohn's disease (CD), ulcerative colitis (UC), or indeterminate colitis with or without PSC were eligible. One-to-one propensity score matching was employed to balance demographic parameters, comorbid conditions, and IBD medications between cohort 1 (IBD) and cohort 2 (IBD and concomitant PSC). The primary endpoint was a composite endpoint including the risk of mortality, hospitalization, and surgery. Risks were expressed as Hazard Ratio (HR) with a 95% confidence interval (CI). Results: A total of 398,980 IBD patients were analyzed (cohort 1: 395,874 and cohort 2: 3106). After propensity-score-matching, 3007 patients from each group were included (mean age 48.1 ± 19.4 years, female 40%, UC 75% CD 24.8%). Approximately 1%–2% of patients were treated with advanced therapies. Cohort 2 patients had a higher risk of experiencing the composite endpoint compared to cohort 1 group (HR:1.32, 95%CI:1.23−1.42). Similarly, a higher risk of hospitalization and mortality was identified in subjects with IBD and concomitant PSC (HR:1.32, 95% CI: 1.22−1.43 and HR: 1.69, 95%CI: 1.46−1.96). Both CD and UC patients with concomitant PSC had a higher risk of achieving the composite endpoint (HR: 1.18, 95%CI: 1.02−1.37 and HR: 1.29, 95%CI: 1.18−1.40). An increased risk of mortality and hospitalization was found both in patients with CD (HR: 2.16, 95%CI:1.58−2.95, and 1.20, 95%CI:1.03−1.41) and UC (HR: 1.87, 95%CI: 1.57−2.22 and HR: 1.27, 95%CI:1.16−1.40) and concomitant PSC. Conclusion: In this administrative study of patients with IBD and PSC, concomitant PSC was associated with an increased risk of mortality and hospitalization.