Ahmed Heidi S, Pedersen Natalie, Jayanna Manju Bengaluru, Ten Eyck Patrick, Sanchez Antonio, Murali Arvind R
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Division of Gastroenterology and Hepatology, Boston University Medical Center, 85 E. Concord Street, Boston, MA, 02118, USA.
J Gen Intern Med. 2020 May;35(5):1523-1529. doi: 10.1007/s11606-020-05725-1. Epub 2020 Mar 10.
Non-alcoholic fatty liver disease (NAFLD) is one of the most common causes of cirrhosis in the USA.
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.
Retrospective cohort study.
Seven hundred patients with NAFLD met inclusion criteria for the study. Patients were divided into model construction (n = 450) and validation (n = 250) cohorts.
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.
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).
A significant proportion of patients with NAFLD developed hepatic decompensation. We have provided a simple, objective model to help identify "at-risk" patients.
非酒精性脂肪性肝病（NAFLD）是美国肝硬化最常见的病因之一。
我们旨在确定NAFLD患者发生肝脏事件的时间，并建立一个简单模型以识别有肝失代偿风险的患者。
回顾性队列研究。
700例NAFLD患者符合研究纳入标准。患者被分为模型构建组（n = 450）和验证组（n = 250）。
在诊断NAFLD时收集人口统计学、临床和实验室变量。Kaplan-Meier分析确定从初始诊断到发生肝脏事件的时间。在模型构建组中使用多变量Cox比例风险模型建立事件发生时间预测模型，然后进行内部验证。
49例（7%）患者在初始诊断后平均6.2±4.2年发生肝脏事件。在5年、10年和12年时发生肝脏事件的Kaplan-Meier概率分别为4.8%、10.6%和11.3%。年龄、糖尿病的存在和血小板计数被确定为预测肝脏事件的显著变量。NAFLD失代偿风险评分被制定为“年龄×0.06335 + 糖尿病的存在（是 = 1，否 = 0）×0.92221 - 血小板计数×0.01522”以预测肝失代偿的概率。风险评分模型的曲线下面积为0.89（95%CI = 0.92，0.86），在验证组（0.91，0.87 - 0.94）和整个队列（0.89，0.87 - 0.91）中表现良好。
相当一部分NAFLD患者发生了肝失代偿。我们提供了一个简单、客观的模型来帮助识别“高危”患者。
