Some patients with nonalcoholic fatty liver disease (NAFLD) develop liver-related complications, and have higher mortality than other patients with NAFLD.
Dr Paul Angulo and colleagues from Kentucky, USA determined the accuracy of simple, noninvasive scoring systems in identification of patients at increased risk for liver-related complications or death.
The research team performed a retrospective, international, multicenter cohort study of 320 patients diagnosed with NAFLD, based on liver biopsy analysis through 2002 and followed through 2011.
Patients were assigned to mild-, intermediate-, or high-risk groups based on cut-off values for 2 of the following; NAFLD fibrosis score, aspartate aminotransferase/platelet ratio index, FIB-4 score, and BARD score.
Outcomes included liver-related complications and death or liver transplantation.
|14% of patients developed liver-related events|
The researchers used multivariate Cox proportional hazard regression analysis to adjust for relevant variables and calculate adjusted hazard ratios.
During a median follow-up period of 105 months, 14% of patients developed liver-related events, and 13% died or underwent liver transplantation.
The adjusted hazard ratios for liver-related events in the intermediate-risk and high-risk groups, compared with the low-risk group, were 8, and 34, respectively.
Based on NAFLD fibrosis score, the adjusted hazard ratios for liver-related events in the intermediate-risk and high-risk groups were 8.8, and 21 based on the aspartate aminotransferase/platelet ratio index; and 6.2 and 6.6 based on the BARD score.
The adjusted hazard ratios for death or liver transplantation in the intermediate-risk and high-risk groups compared with the low-risk group were 4.2, and 9.8, respectively, based on the NAFLD fibrosis scores.
Based on aspartate aminotransferase/platelet ratio index and FIB-4 score, only the high-risk group had a greater risk of death or liver transplantation.
Dr Angulo's team concludes, "Simple noninvasive scoring systems help identify patients with NAFLD who are at increased risk for liver-related complications or death."
"NAFLD fibrosis score appears to be the best indicator of patients at risk."
"The results of this study require external validation."