S78 Evaluating Survival and Clinical Outcomes in Primary Biliary Cholangitis vs Primary Sclerosing Cholangitis: A Large-Scale Propensity-Matched Database Study

Introduction: Primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC) are rare cholestatic liver diseases with distinct pathophysiology and clinical trajectories. Limited large-scale comparative data exist regarding long-term outcomes between these conditions. This study aimed to compare survival and clinical progression patterns between patients with PBC and PSC using real-world data. Methods: We conducted a retrospective cohort study using the TriNetX Global Collaborative Network, encompassing 146 healthcare organizations. Patients with PBC (ICD-10: K74.3) and PSC (ICD-10: K83.01) were identified and followed for up to 5 years. After propensity score matching for demographics and comorbidities, cohorts of 11,957 patients each were analyzed. Primary outcome was all-cause mortality. Secondary outcomes included cardiovascular events, malignancies, hepatic complications, and hospitalizations. Outcomes were analyzed using Kaplan-Meier survival analysis with hazard ratios and risk analysis. Results: In propensity-matched cohorts, PBC patients demonstrated slightly higher mortality (12.6% vs 12.1%; HR 1.105, 95% CI 1.028-1.188; P = 0.007). PBC was associated with increased risks of heart failure (5.5% vs 4.9%; HR 1.226, P = 0.001), chronic kidney disease (9.8% vs 8.8%; HR 1.185, P < 0.001), cerebrovascular disease (5.5% vs 4.5%; HR 1.309, P < 0.001), and acute myocardial infarction (2.8% vs 2.2%; HR 1.363, P < 0.001). No significant difference was observed in atrial fibrillation rates (3.9% vs 4.1%; HR 1.014, P = 0.836). PSC patients had higher risks of cholangiocarcinoma (3.5% vs 0.9%; HR 0.279, P < 0.001), colon cancer (1.2% vs 0.4%; HR 0.312, P < 0.001), and pulmonary embolism (1.8% vs 1.3%; HR 0.747, P = 0.006). Conclusion: This large-scale analysis reveals distinct clinical trajectories between PBC and PSC. While PBC patients face higher cardiovascular and renal complications, PSC patients demonstrate increased malignancy risk, particularly cholangiocarcinoma and colon cancer. These findings inform risk stratification and surveillance strategies for both conditions.