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September 10, 2025Open Access

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

Key Points

Patients with inflammatory bowel disease and primary sclerosing cholangitis show a 1.32-fold increased risk of mortality and hospitalization.
In this large cohort study, data from over 398,000 IBD patients were analyzed, demonstrating significant risks associated with PSC.
A retrospective analysis leveraging propensity score matching clarified differential outcomes between IBD alone and IBD with PSC.
These findings suggest that clinicians should monitor IBD patients closely for complications if they also have primary sclerosing cholangitis.

Abstract

ABSTRACT 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.

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Cite This Study

D’Amico et al. (Mon,) studied this question.

synapsesocial.com/papers/68c1956b9b7b07f3a06198f2 https://doi.org/https://doi.org/10.1002/ueg2.70058

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