Ahmed Heidi S, Gangasani Nikitha, Jayanna Manju B, Long Michelle T, Sanchez Antonio, Murali Arvind R
Boston University School of Medicine, Section of Gastroenterology, Boston, MA, USA.
Boston University School of Medicine, Department of Internal Medicine, Boston, MA, USA.
J Clin Exp Hepatol. 2023 Mar-Apr;13(2):233-240. doi: 10.1016/j.jceh.2022.11.005. Epub 2022 Nov 12.
The NAFLD decompensation risk score (the Iowa Model) was recently developed to identify patients with nonalcoholic fatty liver disease (NAFLD) at highest risk of developing hepatic events using three variables-age, platelet count, and diabetes.
We performed an external validation of the Iowa Model and compared it to existing non-invasive models.
We included 249 patients with NAFLD at Boston Medical Center, Boston, Massachusetts, in the external validation cohort and 949 patients in the combined internal/external validation cohort. The primary outcome was the development of hepatic events (ascites, hepatic encephalopathy, esophageal or gastric varices, or hepatocellular carcinoma). We used Cox proportional hazards to analyze the ability of the Iowa Model to predict hepatic events in the external validation (https://uihc.org/non-alcoholic-fatty-liver-disease-decompensation-risk-score-calculator). We compared the performance of the Iowa Model to the AST-to-platelet ratio index (APRI), NAFLD fibrosis score (NFS), and the FIB-4 index in the combined cohort.
The Iowa Model significantly predicted the development of hepatic events with hazard ratio of 2.5 [95% confidence interval (CI) 1.7-3.9, < 0.001] and area under the receiver operating characteristic curve (AUROC) of 0.87 (CI 0.83-0.91). The AUROC of the Iowa Model (0.88, CI: 0.85-0.92) was comparable to the FIB-4 index (0.87, CI: 0.83-0.91) and higher than NFS (0.66, CI: 0.63-0.69) and APRI (0.76, CI: 0.73-0.79).
In an urban, racially and ethnically diverse population, the Iowa Model performed well to identify NAFLD patients at higher risk for liver-related complications. The model provides the individual probability of developing hepatic events and identifies patients in need of early intervention.
非酒精性脂肪性肝病（NAFLD）失代偿风险评分（爱荷华模型）最近被开发出来，用于通过年龄、血小板计数和糖尿病这三个变量来识别发生肝脏事件风险最高的非酒精性脂肪性肝病患者。
我们对爱荷华模型进行了外部验证，并将其与现有的非侵入性模型进行比较。
我们将马萨诸塞州波士顿市波士顿医疗中心的249例NAFLD患者纳入外部验证队列，将949例患者纳入内部/外部联合验证队列。主要结局是发生肝脏事件（腹水、肝性脑病、食管或胃静脉曲张或肝细胞癌）。我们使用Cox比例风险模型分析爱荷华模型在外部验证中预测肝脏事件的能力（https://uihc.org/non-alcoholic-fatty-liver-disease-decompensation-risk-score-calculator）。我们在联合队列中比较了爱荷华模型与天冬氨酸转氨酶与血小板比值指数（APRI）、NAFLD纤维化评分（NFS）和FIB-4指数的性能。
爱荷华模型显著预测了肝脏事件的发生，风险比为2.5[95%置信区间（CI）1.7 - 3.9，P < 0.001]，受试者工作特征曲线下面积（AUROC）为0.87（CI 0.83 - 0.91）。爱荷华模型的AUROC（0.88，CI：0.85 - 0.92）与FIB-4指数（0.87，CI：0.83 - 0.91）相当，高于NFS（0.66，CI：0.63 - 0.69）和APRI（0.76，CI：0.73 - 0.79）。
在一个城市的、种族和民族多样化的人群中，爱荷华模型在识别发生肝脏相关并发症风险较高的NAFLD患者方面表现良好。该模型提供了发生肝脏事件的个体概率，并识别出需要早期干预的患者。
