Abstract
It is important to rapidly identify patients with advanced liver disease. Routine tests to assess liver function and fibrosis provide data that can be used to determine patients' prognoses. We tested the validated the ability of combined data from the ALBI and FIB-4 scoring systems to identify patients with compensated cirrhosis at highest risk for decompensation. We collected data from 145 patients with compensated cirrhosis (91% Child A cirrhosis and median MELD scores below 8) from a cohort in Nottingham, United Kingdom, followed for a median 4.59 years (development cohort). We collected baseline clinical features and recorded decompensation events. We used these data to develop a model based on liver function (assessed by the ALBI score) and extent of fibrosis (assessed by the FIB-4 index) to determine risk of decompensation. We validated the model in 2 independent external cohorts (1 in Dublin, Ireland and 1 in Menoufia, Egypt) comprising 234 patients. In the development cohort, 19.3% of the patients developed decompensated cirrhosis. Using a combination of ALBI and FIB-4 scores, we developed a model that identified patients at low vs high risk of decompensation (hazard ratio [HR] for decompensation in patients with high risk score was 7.10). When we tested the scoring system in the validation cohorts, the HR for decompensation in patients with a high-risk score was 12.54 in the Ireland cohort and 5.10 in the Egypt cohort. We developed scoring system, based on a combination of ALBI and FIB-4 scores, that identifies patients at risk for liver decompensation. We validated the scoring system in 2 independent international cohorts (Europe and the Middle East), so it appears to apply to diverse populations.
Highlights
The progression of chronic liver disease (CLD), from fibrosis to clinical outcomes, and clinical sequelae including liver decompensation manifest relatively late in the natural history and are often the index presentation of liver disease [1]
The Child Pugh and MELD score are extensively validated and applicable tools that have been used for decades in clinical practice; the caveats that limit their performance have been previously documented [24]
The Dublin cohort comprised of 141 patients with cirrhosis (90% Child Pugh Grade A)
Summary
The progression of chronic liver disease (CLD), from fibrosis to clinical outcomes, and clinical sequelae including liver decompensation (ascites, variceal bleeding and encephalopathy) manifest relatively late in the natural history and are often the index presentation of liver disease [1]. The Child Pugh and MELD score are extensively validated and applicable tools that have been used for decades in clinical practice; the caveats that limit their performance have been previously documented [24]. These scoring systems provide value after synthetic liver function has become significantly deranged and provide only short term prognostic value. There are no scores, performed in routine clinical practice, that provide robust prognostic stratification within early, compensated cirrhosis over the medium/long term. We tested the validated the ability of combined data from the ALBI and FIB-4 scoring systems to identify patients with compensated cirrhosis at highest risk for decompensation
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