TY - JOUR
T1 - Magnetic resonance elastography-based prediction model for hepatic decompensation in NAFLD
T2 - A multicenter cohort study
AU - Kim, Beom Kyung
AU - Bergstrom, Jaclyn
AU - Loomba, Rohan
AU - Tamaki, Nobuharu
AU - Izumi, Namiki
AU - Nakajima, Atsushi
AU - Idilman, Ramazan
AU - Gumussoy, Mesut
AU - Oz, Digdem K.
AU - Erden, Ayse
AU - Truong, Emily
AU - Yang, Ju Dong
AU - Noureddin, Mazen
AU - Allen, Alina M.
AU - Loomba, Rohit
AU - Ajmera, Veeral
N1 - Funding Information:
Veeral Ajmera is supported by NIDDK (K23DK119460). Rohit Loomba receives funding support from NCATS (5UL1TR001442), NIDDK (U01DK061734, U01DK130190, R01DK106419, R01DK121378, R01DK124318, P30DK120515), NHLBI (P01HL147835), and NIAAA (U01AA029019). Alina M. Allen is supported by K23DK115594 and R03DK128127.
Publisher Copyright:
© 2023 John Wiley and Sons Inc.. All rights reserved.
PY - 2023/12
Y1 - 2023/12
N2 - BACKGROUND AND AIMS: Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD.APPROACH AND RESULTS: This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts ( p < 0.05).CONCLUSIONS: An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
AB - BACKGROUND AND AIMS: Magnetic resonance elastography (MRE) is an accurate, continuous biomarker of liver fibrosis; however, the optimal combination with clinical factors to predict the risk of incident hepatic decompensation is unknown. Therefore, we aimed to develop and validate an MRE-based prediction model for hepatic decompensation for patients with NAFLD.APPROACH AND RESULTS: This international multicenter cohort study included participants with NAFLD undergoing MRE from 6 hospitals. A total of 1254 participants were randomly assigned as training (n = 627) and validation (n = 627) cohorts. The primary end point was hepatic decompensation, defined as the first occurrence of variceal hemorrhage, ascites, or HE. Covariates associated with hepatic decompensation on Cox-regression were combined with MRE to construct a risk prediction model in the training cohort and then tested in the validation cohort. The median (IQR) age and MRE values were 61 (18) years and 3.5 (2.5) kPa in the training cohort and 60 (20) years and 3.4 (2.5) kPa in the validation cohort, respectively. The MRE-based multivariable model that included age, MRE, albumin, aspartate aminotransferase, and platelets had excellent discrimination for the 3- and 5-year risk of hepatic decompensation (c-statistic 0.912 and 0.891, respectively) in the training cohort. The diagnostic accuracy remained consistent in the validation cohort with a c-statistic of 0.871 and 0.876 for hepatic decompensation at 3 and 5 years, respectively, and was superior to Fibrosis-4 in both cohorts ( p < 0.05).CONCLUSIONS: An MRE-based prediction model allows for accurate prediction of hepatic decompensation and assists in the risk stratification of patients with NAFLD.
KW - Humans
KW - Non-alcoholic Fatty Liver Disease/complications
KW - Cohort Studies
KW - Elasticity Imaging Techniques
KW - Esophageal and Gastric Varices/etiology
KW - Magnetic Resonance Imaging
KW - Gastrointestinal Hemorrhage/pathology
KW - Liver/diagnostic imaging
KW - Liver Cirrhosis/complications
UR - http://www.scopus.com/inward/record.url?scp=85170560502&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85170560502&partnerID=8YFLogxK
U2 - 10.1097/HEP.0000000000000470
DO - 10.1097/HEP.0000000000000470
M3 - Article
C2 - 37203233
AN - SCOPUS:85170560502
SN - 0270-9139
VL - 78
SP - 1858
EP - 1866
JO - Hepatology
JF - Hepatology
IS - 6
ER -