Abide: A Novel Predictive Model of Liver Decompensation in Patients with Non-Alcoholic Fatty Liver Related Cirrhosis.

Non-alcoholic fatty liver disease (NAFLD) is an increasingly important cause of liver cirrhosis and subsequent complications. We retrospectively developed and validated a model to predict hepatic decompensation in NAFLD patients with cirrhosis and compared this with currently available models. Baseline variables from an international cohort of 299 biopsy-proven NAFLD patients with compensated cirrhosis were examined to construct a model using competing risk multivariate regression and Akaike/Bayesian information criteria. Validation was performed in 244 biopsy-proven NAFLD cirrhosis patients from the United States. Prognostic accuracy was compared with the NAFLD Fibrosis score (NFS), FIB-4, MELD , Child-Turcotte-Pugh (CTP) and ALBI-FIB-4 score using time-dependent area under the curve (tAUC) analysis. During a median follow-up of 5.6 years (range 2.4-14.1) and 5.4 years (range 1.5-13.8), hepatic decompensation occurred in 81 and 132 patients in the derivation and validation cohorts respectively. In the derivation cohort, independent predictors of hepatic decompensation (AST/ALT ratio, Bilirubin, International normalized ratio, type 2 Diabetes and OEsophageal varices) were combined into the ABIDE model. Subjects with a score ≥4.1 compared to those with a score <4.1, had a higher risk of decompensation (sHR 6.7, 95% CI 4.0-11.2, p<0.001), a greater five-year cumulative incidence (37% versus 6%, p<0.001) and shorter mean duration to decompensation (3.8 vs 6.7 years, p<0.001). The accuracy of the ABIDE model at 5 years was good in the derivation (tAUC 0.80, 95% CI 0.73-0.84) and validation cohorts (0.78, 95% CI 0.74-0.81) and was significantly more accurate than the NFS (0.72), FIB-4 (0.74), MELD (0.69), CTP (0.72) and ALBI-FIB-4 (0.73) (all p<0.001). CONCLUSIONS: In NAFLD patients with compensated cirrhosis, ABIDE, a predictive model of routine clinical measures predicts future hepatic decompensation.