IDDF2023-ABS-0051 Laboratory parameter-based model for predicting hepatic complications in non-alcoholic fatty liver disease: a territory-wide cohort study

BackgroundWe aimed to develop a risk score to predict hepatic complications including hepatic decompensation and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease (NAFLD).MethodsThe training cohort included adult NAFLD patients identified using a territory-wide electronic database in Hong Kong between January 2000 and July 2021. A risk score was developed using the Fine-Gray model, assessed by area under the time-dependent receiver operating characteristic curves (AUROCs) with competing risk of non-liver-related death, and compared to FIB-4 index and aspartate aminotransferase to platelet ratio index (APRI). The validation cohort comprised adult patients with type 2 diabetes (T2D) from 2000-2016 who likely had NAFLD detected by a published score. T2D was defined by antidiabetic drug uses, haemoglobin A1c ≥6.5%, fasting glucose ≥7mmol/L, and/or diagnosis codes; patients with diagnosis codes of type 1 diabetes were excluded. Patients with hepatic complications before baseline or follow-upResultsOf 26,993 NAFLD patients in the training cohort (mean age 56.3±13.5 years, 46.1% males, 0.6% cirrhosis, 44.1% diabetes), 282 (1.0%) developed hepatic complications during 148,007 person-years of follow-up. In the validation cohort of 411,395 patients (mean age 61.8±12.4 years, 50.7% males, 0.4% cirrhosis), 5,984 (1.5%) developed hepatic complications during 4,386,580 person-years of follow-up. Age, cirrhosis, diabetes with and without optimal glycaemic control, hypertension, gamma-glutamyl transferase, albumin, total bilirubin, international normalised ratio, and platelet were independently associated with hepatic complications; the risk score with these factors achieved an AUROC (95%CI) of 0.81 (0.77-0.85) at 5 years and around 0.8 over 15 years (IDDF2023-ABS-0051 Figure 1. The AUROC of NAFLD risk score FIB-4 index and APRI over 15 years in the training and validation cohorts, IDDF2023-ABS-0051 Figure 2. The AUROC of NAFLD risk score FIB-4 index and APRI at 5 years in the training and validation cohorts). In validation, the risk score achieved an AUROC of 0.73-0.78 in the first 5 years, and 0.73 (95%CI: 0.71-0.74) at year 5 (IDDF2023-ABS-0051 Figure 1. The AUROC of NAFLD risk score FIB-4 index and APRI over 15 years in the training and validation cohorts, IDDF2023-ABS-0051 Figure 2. The AUROC of NAFLD risk score FIB-4 index and APRI at 5 years in the training and validation cohorts). In both the training and validation cohorts, the risk scor