Clinical decision support
Decision support tools
Guideline-anchored tools that show which published recommendations apply to a given clinical situation. Every recommendation is quoted verbatim from the cited guideline and machine-verified against its full text. These tools surface the evidence, they do not predict outcomes or replace clinical judgment.
Risk Calculators & Guidelines
The published guidelines for IBD-PSC lean on a handful of validated risk models, the AASLD and EASL documents both point to them by name. This page gathers the calculators themselves alongside the guidelines that recommend them, so the tool and the recommendation sit side by side.
For clinicians. These are prognostic and allocation tools used by hepatology, GI, and surgical teams. They estimate risk at a population level. They do not diagnose, and no score should be read as a prediction about any one person. If you have PSC, bring a result to your own team rather than interpreting it alone.
How the liver disease is scored
Each of these predicts transplant-free survival or decompensation from routine labs. They differ in what they were trained on and how far ahead they look.
Revised Mayo PSC Risk Score
The long-standing benchmark. Age, bilirubin, AST, albumin, and history of variceal bleeding, no liver biopsy needed. Predicts survival probability out to 4 years.
MDCalc version · Kim WR, et al. Mayo Clin Proc 2000;75(7):688–694. PMID 10907383
PREsTo
PSC Risk Estimate Tool, a machine-learning model using nine routine variables to predict hepatic decompensation at 5 years. Outperformed both MELD and the Mayo score in validation (C-statistic 0.90).
Its exclusions remove much of the surgical population. PREsTo was not tested in small-duct PSC, PSC–autoimmune hepatitis overlap, MELD above 14, prior liver transplant, established portal hypertension (varices, ascites, encephalopathy, or platelets under 150), or age under 18. It predicts hepatic decompensation only, not cholangiocarcinoma, not colorectal cancer, and not perioperative risk.
On load the output panel shows a red error until you tick the eligibility box. It is not broken.
Eaton JE, et al. Hepatology 2020;71(1):214–224. PMID 29742811
UK-PSC risk scores
Two scores from a cohort of over 1,000 UK patients: a short-term score at diagnosis predicting 2-year transplant-free survival, and a long-term score at 2 years predicting 10-year survival.
Patient-facing explainer (PSC Support) · Goode EC, et al. Hepatology 2019;69(5):2120–2135. PMID 30566748
Amsterdam-Oxford Model
Built on a largely population-based Dutch cohort and validated in the UK. Uses age at diagnosis, PSC subtype (large- vs small-duct), albumin, ALP, AST, bilirubin, and platelets. No official hosted calculator. The equation is published in full. Uniquely, it includes small-duct PSC and PSC–AIH overlap, the groups PREsTo excludes.
Weaker discrimination than the tools above: C-statistic 0.68 (95% CI 0.51–0.85), a confidence interval reaching near-chance. Useful where PREsTo does not apply; not co-equal to it.
de Vries EMG, et al. Gut 2018;67(10):1864–1869. PMID 28739581 · free full text
Enhanced Liver Fibrosis (ELF) score
A serum fibrosis panel, not a formula you compute yourself. It is ordered as a lab test. Predicts transplant-free survival in PSC and adds prognostic information beyond the clinical scores above.
Vesterhus M, et al. Hepatology 2015;62(1):188–197. PMID 25833813
Liver allocation
MELD is what determines position on the US transplant waiting list, a different question from the prognostic scores above, which describe the disease rather than the queue.
MELD 3.0
The current US allocation standard since 2023. Adds female sex and serum albumin to the older MELD-Na, with a lower creatinine ceiling.
MDCalc (MELD 3.0, MELD-Na, original MELD) · Kim WR, et al. Gastroenterology 2021;161(6):1887–1895. PMID 34481845
Why MELD under-reads PSC
MELD captures synthetic liver failure. It does not capture recurrent cholangitis, intractable itch, or dominant strictures, the complications that often drive the need for transplant in PSC. This is the rationale for exception points, and it is discussed in both the AASLD and EASL documents below.
Compare transplant centers (SRTR)
The Scientific Registry of Transplant Recipients publishes program-specific outcomes for every US liver transplant program. Waitlist time, transplant rate, and graft and patient survival, each reported against what would be expected for that program’s case mix. Updated every January and July.
National transplant data (UNOS / OPTN)
System-level trends rather than center-level scorecards, how many liver transplants are done, waitlist size, and how allocation is changing over time.
Read a center report alongside the guidelines, not instead of them: an expected-vs-observed figure describes a program’s whole population, and PSC is a small and atypical slice of it.
Colorectal surveillance risk
There is no validated, publicly hosted calculator for colorectal cancer risk in IBD-PSC. Surveillance is interval-based, and PSC itself is the risk factor that sets the interval.
What the guidelines say instead of a score
PSC moves a person straight to the shortest surveillance interval. Annual colonoscopy from the time of PSC diagnosis, regardless of how long the colitis has been present or how mild it looks. That recommendation is common to the AASLD, EASL, ACG, and AGA documents below.
Dynamic prediction of advanced neoplasia
A research model that updates risk as surveillance findings accumulate over time, rather than fixing it at diagnosis. Not yet a bedside tool, but the direction the field is moving.
Wijnands AM, et al. Clin Gastroenterol Hepatol 2024;22(8):1697–1708. PMID 38431223
UC-CaRE: risk after a dysplasia diagnosis
The one validated, freely usable tool in this space: it converts a dysplasia finding in UC into an individualised colorectal-cancer risk, designed for the conversation with the patient rather than for the chart. Externally validated with observed-to-expected 1.01.
Read the PSC caveat before using it here. The tool states that it under-estimates risk when PSC is present, which is this site's entire population. In IBD-PSC treat the output as a floor and a discussion aid, not as the number.
Curtius K, et al. Multicentre derivation and validation of a colitis-associated colorectal cancer risk prediction web tool. Gut 2022;71(4):705–715. PMID 33990383
PSC and the liver
AASLD Practice Guidance on PSC and cholangiocarcinoma (2022)
The current US reference. Covers diagnosis, MRCP surveillance, dominant strictures, hepatobiliary cancer surveillance, transplant, and the IBD-PSC colon, and names the prognostic models above.
Bowlus CL, et al. Hepatology 2023;77(2):659–702. Full text · PMID 36083140
EASL Clinical Practice Guidelines on sclerosing cholangitis (2022)
The European counterpart, published the same year. Graded recommendations across diagnosis, medical therapy, cancer surveillance, and transplantation.
European Association for the Study of the Liver. J Hepatol 2022;77(3):761–806. Full text · PMID 35738507
BSG and UK-PSC guidelines (2019)
The UK guideline, from the same group behind the UK-PSC risk scores.
Chapman MH, et al. Gut 2019;68(8):1356–1378. PMID 31154395
ACG Clinical Guideline: Primary Sclerosing Cholangitis (2015)
Older, but still the ACG's formal statement and widely cited.
Lindor KD, et al. Am J Gastroenterol 2015;110(5):646–659. PMID 25869391
Japan Biliary Association clinical guidelines for PSC (2017)
Sixteen Delphi-derived recommendations with diagnostic and therapeutic flowcharts. Worth reading alongside the Western documents: PSC in Japan has a different age distribution and a markedly lower rate of associated IBD, so the guidance is not simply a translation of AASLD or EASL.
Isayama H, et al. J Gastroenterol 2018;53(9):1006–1034. PMID 29951926
AGA Clinical Practice Update: hepatobiliary cancer surveillance in PSC (2019)
Focused guidance on screening for cholangiocarcinoma and gallbladder cancer. Imaging modality, interval, and what to do with a suspicious finding.
Bowlus CL, et al. Clin Gastroenterol Hepatol 2019;17(12):2416–2422. PMID 31306801
The colitis, surveillance, and surgery
ACG Clinical Guideline Update: Ulcerative Colitis in Adults (2025)
The current ACG medical-management reference, 54 graded recommendations and 57 key concepts. This is the medical-optimisation context against which colectomy timing is judged.
Am J Gastroenterol 2025. PMID 40701556
Updates the 2019 guideline (Rubin DT, et al. Am J Gastroenterol 2019;114(3):384–413, PMID 30840605).
ECCO Guidelines on IBD and Malignancies (2023)
Cancer risk and dysplasia management in colonic IBD. PSC is treated as a distinct high-risk stratum warranting additional random biopsies; also covers visible versus invisible dysplasia and pouch neoplasia risk after IPAA.
J Crohns Colitis 2023. PMID 36528797
AGA Clinical Practice Guideline on Pouchitis and Inflammatory Pouch Disorders (2024)
GRADE guidance on pouchitis, Crohn’s-like disease of the pouch, and cuffitis. Relevant here because PSC is a recognised risk factor for chronic pouchitis after IPAA, the reason pouch decisions in PSC differ from pouch decisions in UC generally.
Gastroenterology 2024;166(1):59–85. PMID 38128971
ASCRS Clinical Practice Guidelines: Surgical Management of Ulcerative Colitis (2026)
The current surgical guideline, indications and timing of colectomy, IPAA versus end ileostomy, and management of UC-associated dysplasia and cancer, including in PSC. Explicitly rejects watch-and-wait for UC-associated adenocarcinoma.
Lightner AL, et al. Dis Colon Rectum 2026. PMID 42165399
Supersedes the 2021 edition (Holubar SD, et al. Dis Colon Rectum 2021;64(7):783–804, PMID 33853087), which remains the citation for anything referencing that version.
ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment (2026)
The European surgical counterpart, perioperative optimisation, staging of colectomy and IPAA, technique, and centre-expertise thresholds. The colectomy-decision reference for PSC-UC alongside the ASCRS document.
J Crohns Colitis 2026. PMID 42381162
Liver Transplantation for PSC With or Without IBD, ESOT Consensus (2023)
The most directly surgical PSC-IBD document there is: indications and timing of transplant, and the timing and extent of colectomy relative to transplant. Argues for a lower threshold for colectomy in PSC-IBD than in IBD alone, referral after failing one to two biologics.
Transpl Int 2023. PMID 37841645
AGA Clinical Practice Update: endoscopic surveillance and management of colorectal dysplasia in IBD (2021)
Practical guidance on how surveillance colonoscopy should be done and what to do with dysplasia once found.
Murthy SK, et al. Gastroenterology 2021;161(3):1043–1051. PMID 34416977
SCENIC international consensus on dysplasia in IBD (2015)
The consensus that reframed dysplasia terminology and endorsed chromoendoscopy, still the vocabulary the field uses.
Laine L, et al. Gastrointest Endosc 2015;81(3):489–501. PMID 25708752
ECCO Guidelines on Extraintestinal Manifestations in IBD (2024)
Places PSC within the broader set of extraintestinal manifestations and sets out how it should be managed alongside the bowel disease.
Gordon H, et al. J Crohns Colitis 2024;18(1):1–37. PMID 37351850
Where the guidelines disagree Advanced
The two 2022 documents agree on far more than they differ on, but the gaps are worth knowing. Ursodeoxycholic acid is the clearest: neither recommends it routinely, and both note the harm signal at high dose. Yet practice varies widely. Cholangiocarcinoma surveillance intervals and the role of ERCP in a dominant stricture are stated with different degrees of confidence. And the timing of colectomy relative to transplant is addressed only in general terms by both, which is precisely the decision an IBD-PSC patient faces.
For the surgical side of that decision, see Surgery & the J-Pouch; for the underlying literature, References.
Also on MDCalc
These are established instruments already hosted as free, working calculators by MDCalc. We link them rather than rebuild them. Our own decision-support tools above cover what MDCalc does not, and every link below was verified against MDCalc directly.
- Montreal Classification for IBD Note: A PHENOTYPE classification, not a prediction model. Extent should be recorded as the maximum ever documented, not the most recent endoscopic appearance, which underestimates true extent in quiescent disease.
- Truelove and Witts Severity Index for Ulcerative Colitis Note: A 1955 classification, not a prediction model, never validated to predict steroid failure or colectomy. Deliberately sensitive rather than specific: only ONE systemic criterion beyond the stool count is needed.
- Mayo Score / Disease Activity Index (DAI) for Ulcerative Colitis Note: An ACTIVITY index, not a risk model. The endoscopic subscore requires a scope, so the 'partial Mayo' seen in clinic is a different instrument with different thresholds, say which one you mean.
- Ulcerative Colitis Endoscopic Index of Severity (UCEIS) Note: NOTE the published scoring was CORRECTED: BSG 2019's table 3 printed the original scale where normal = 1 (range 3-11); the corrected scale is normal = 0 (range 0-8). Confirm which scale a given source is using before comparing scores.
- Travis Criteria (Oxford Index) Note: Identifies patients who should be considered for rescue therapy or surgery. It does not decide for them. Applied on day 3 of IV steroids, not on admission.
Guideline summaries hosted by MDCalc:
- ACG: Preventive Care in Inflammatory Bowel Disease (via MDCalc) Note: Directly relevant before starting biologics or immunomodulators, and a frequent gap in surgical clinics.