Mousa OY, Juran BD, McCauley BM, et al. - In the present study, the researchers sought to assess the clinical utility of bile acid (BA) profiling in primary sclerosing cholangitis (PSC) utilizing traditional and machine-learning approaches. Plasma BA profiling was conducted in the Clinical Biochemical Genetics Laboratory at Mayo Clinic utilizing a mass spectrometry based assay. Cox proportional hazard (univariate) and gradient boosting machines (multivariable) models were used to assess whether BA variables anticipate 5-year risk of hepatic decompensation (HD; defined as ascites, variceal hemorrhage, or encephalopathy). In the derivation cohort (Mayo Clinic), there were 400 patients with PSC and 302 controls, and in the validation cohort (Norwegian PSC Research Center), there were 108 patients with PSC. Patients with PSC showed changes of plasma BA consistent with known mechanisms of cholestasis, ursodeoxycholic acid treatment, and inflammatory bowel disease. Notably, BA profiles predicted future HD, indicating that BA profiling has clinical potential and could be used in clinical trials.