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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predicting liver-related events in NAFLD: A predictive model
Hepatology, Volume 78, No. 4, Year 2023
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Description
Background and Aims: Management of NAFLD involves noninvasive prediction of fibrosis, which is a surrogate for patient outcomes. We aimed to develop and validate a model predictive of liver-related events (LREs) of decompensation and/or HCC and compare its accuracy with fibrosis models. Approach and Results: Patients with NAFLD from Australia and Spain who were followed for up to 28 years formed derivation (n = 584) and validation (n = 477) cohorts. Competing risk regression and information criteria were used for model development. Accuracy was compared with fibrosis models using time-dependent AUC analysis. During follow-up, LREs occurred in 52 (9%) and 11 (2.3%) patients in derivation and validation cohorts, respectively. Age, type 2 diabetes, albumin, bilirubin, platelet count, and international normalized ratio were independent predictors of LRE and were combined into a model [NAFLD outcomes score (NOS)]. The NOS model calibrated well [calibration slope, 0.99 (derivation), 0.98 (validation)] with excellent overall performance [integrated Brier score, 0.07 (derivation) and 0.01 (validation)]. A cutoff ≥1.3 identified subjects at a higher risk of LRE, (sub-HR 24.6, p < 0.001, 5-year cumulative incidence 38% vs 1.0%, respectively). The predictive accuracy at 5 and 10 years was excellent in both derivation (time-dependent AUC,0.92 and 0.90, respectively) and validation cohorts (time-dependent AUC,0.80 and 0.82, respectively). The NOS was more accurate than the fibrosis-4 or NAFLD fibrosis score for predicting LREs at 5 and 10 years (p < 0.001). Conclusions: The NOS model consists of readily available measures and has greater accuracy in predicting outcomes in patients with NAFLD than existing fibrosis models. © 2023 John Wiley and Sons Inc.. All rights reserved.
Authors & Co-Authors
de Boer, Bastiaan W.
Australia, Perth
Pathwest Laboratory Medicine wa
George, Jacob
Australia, Parramatta
The Westmead Institute for Medical Research
Eslam, Mohammed
Australia, Parramatta
The Westmead Institute for Medical Research
Ampuero, Javier
Spain, Madrid
Consejo Superior de Investigaciones Científicas
Romero-Gómez, Manuel Pérez
Spain, Madrid
Consejo Superior de Investigaciones Científicas
Adams, Leon Anton
Australia, Perth
The University of Western Australia
Australia, Perth
Sir Charles Gairdner Hospital
Statistics
Authors: 6
Affiliations: 6
Identifiers
Doi:
10.1097/HEP.0000000000000356
ISSN:
02709139
Research Areas
Health System And Policy
Noncommunicable Diseases
Study Design
Cohort Study