2026. EASL Congress Abstract and Poster: Acute cholangitis in primary sclerosing cholangitis: profile classification of patient-reported symptom burdens predicts recovery from cholangitis episodes

Authors: Brian T. Thorsen, Martine Walmsley, Mary P. Vyas, Mark Chatterley, Stephen J. Rossi

Background and Aims: Acute cholangitis (AC) is a significant complication in patients living with primary sclerosing cholangitis (PSC). Previous data showed a significant and highly variable symptom burden during AC. We aim to identify patterns in symptom presentation which may link to patient characteristics and post-AC recovery.

Method: A de-identified survey was distributed to adults with PSC and ≥1 AC episode by PSC Partners Patient Registry and PSC Support. Patient characteristics, AC symptom frequency, severity, and change during the latest AC episode, and medical interventions were collected. Symptom profile classes (SPCs) were developed by latent class analysis (LCA) based on severity of AC symptoms, such as liver pain, fatigue, pruritus, fever, nausea, jaundice, anxiety, and depression. SPCs were analyzed for categorical associations with clinical and demographic variables, interventions, and patient-reported recovery after AC.

Results: A total of 564 responses met screening criteria. Clinical characteristics are consistent with other cohorts, except for 45% male. All AC symptoms had >50% prevalence except jaundice (43%) and vomiting (40%), with highest prevalence of fatigue (90%) and liver pain (84%).

Three SPCs were identified by LCA and interpretability, labeled as Low, Medium, and High, each containing 25%, 45%, and 30% of patients. Most symptoms had increasing incidence and severity across SPC. The High SPC had the greatest incidence and severity in all symptoms: 100% with moderate/severe fatigue and >75% with moderate/severe liver pain, fever, nausea, anorexia, and insomnia. The Low SPC had mostly lower incidence, including 12% with brain fog vs. 66% and 92% in Medium and High. However, the Low SPC had higher rates of severe liver pain, fever, nausea, and vomiting than the Medium SPC (all p < 0.05).

Full recovery to baseline health after AC was strongly associated with SPC (Low: 90%, Medium: 76%, High: 52%, p < 0.001). Longer recoveries were associated with higher SPC (p < 0.001). Antibiotic use was weakly associated with SPC (p = 0.03). Women were more likely to be in the High SPC vs. the Low SPC (p = 0.002). No other demographics were associated with SPC. The SPC model shows fever and nausea alone during AC indicate a milder or treatable case of AC and a likely full recovery.

Conclusion: There is an overall gradient of symptom burden in AC, and higher burdens have worse recovery. Fatigue, liver pain, fever, nausea, and brain fog are key symptoms to understand the symptom burden of AC.