1 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA. firstname.lastname@example.org.
2 Division of Gastroenterology and Hepatology, Boston University Medical Center, 85 E. Concord Street, Boston, MA, 02118, USA. email@example.com.
3 Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
4 Lankenau Institute for Medical Research, Wynnewood, PA, USA.
5 Biostatistics and Research Design, Institute of Clinical and Translational Science, University of Iowa, Iowa City, IA, USA.
6 Division of Gastroenterology and Hepatology, The University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52240, USA.
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cirrhosis in the USA.
OBJECTIVES: We aimed to determine the time to develop hepatic events in patients with NAFLD and develop a simple model to identify patients at risk for hepatic decompensation.
DESIGN: Retrospective cohort study.
PATIENTS: Seven hundred patients with NAFLD met inclusion criteria for the study. Patients were divided into model construction (n = 450) and validation (n = 250) cohorts.
MAIN MEASURES: Demographic, clinical, and laboratory variables were gathered at the time of diagnosis of NAFLD. Kaplan-Meier analysis determined the time to development of hepatic events from initial diagnosis. A time-to-event prediction model was established in the model construction cohort using the multivariate Cox proportional hazards model and was then internally validated.
KEY RESULTS: Forty-nine (7%) patients developed hepatic events at a mean duration of 6.2 ± 4.2 years from initial diagnosis. Kaplan-Meier probability of developing a hepatic event at 5-, 10-, and 12-year intervals was 4.8%, 10.6%, and 11.3%, respectively. Age, presence of diabetes, and platelet count were identified as significant variables to predict hepatic events. NAFLD decompensation risk score was developed as "age × 0.06335 + presence of diabetes (yes = 1, no = 0) × 0.92221 - platelet count × 0.01522" to predict the probability of hepatic decompensation. Risk score model had an area under the curve of 0.89 (95% CI = 0.92, 0.86) and it performed well in both the validation (0.91, 0.87-0.94) and the overall cohort (0.89, 0.87-0.91).
CONCLUSIONS: A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify "at-risk" patients.