Younossi ZM, et al. - Using a large real-world database, researchers identified factors correlated with alkaline phosphatase (ALP)≥1.5×upper limit of normal (ULN) or cirrhosis in primary biliary cholangitis (PBC) and assessed concomitant health care resource utilization. Of 195 million patients included in the database, 36,317 were PBC adults. Investigators found that patients with ALP≥1.5×ULN were more frequently female, had less Medicaid coverage, had more pruritus, cirrhosis, and other autoimmune diseases. In multivariate analysis, older age, female gender, the presence of other autoimmune diseases, and having compensated or decompensated cirrhosis were independently related to having ALP≥1.5×ULN in PBC. In contrast, higher risk of cirrhosis in PBC was associated with being male. Patients with ALP≥1.5×ULN and/or with cirrhosis also had a significant increase in the use of health care resources. They concluded that many clinical, sociodemographic, and economic factors were linked to a potentially more aggressive profile of PBC with elevated ALP. These data may provide physicians with information about implementing management strategies to optimize care for these patients.