Clinicians develop model to calculate patient risk for NAFLD decompensation

Non-alcoholic fatty liver disease (NAFLD) is one of the most common liver diseases worldwide and is associated with conditions such as obesity and metabolic syndrome, which can lead to diabetes, stroke, and heart disease. Although common, identifying people who could be at risk for NAFLD decompensation can be challenging for physicians.

“We needed a way to easily identify patients with NAFLD who are at increased risk of developing hepatic decompensation before they develop clinically obvious cirrhosis and portal hypertension,” Arvind Murali, MBBS, said. “A simple-to-use objective score that all clinicians can easily use would be an ideal answer to this question.”

Murali, clinical assistant professor, and Antonio Sanchez, MD, clinical professor, both in Gastroenterology and Hepatology, worked with a team of researchers to develop a risk score calculator, the Iowa NAFLD Decompensation Risk Model, that would identify patients with NAFLD at increased risk of development of hepatic decompensation. The team published their findings in the Journal of General Internal Medicine.  

In a sample of about 700 patients with NAFLD, the Kaplan-Meier time to development of hepatic decompensation was 4.8%, 10.6%, and 11.3% at 5, 10, and 12 years from the time of diagnosis of NAFLD, respectively. This data was used to develop the risk score. They then validated these scores with 250 more patients.

“Our Iowa NAFLD Decompensation Risk Model is a novel and easy-to-use clinical tool, validated in different populations, that incorporates simple variables (age, platelet count, and presence of diabetes) to identify patients with NAFLD at a higher risk of progression to cirrhosis and development of hepatic events,” Sanchez said.

“Clinicians can now use this score to determine which of their patients are at high risk for developing cirrhosis and hepatic decompensation and offer aggressive intervention and/or referral to liver clinics,” Murali said.

The Iowa NAFLD hepatic decompensation risk score calculator can be accessed online.

Murali and Sanchez worked with UI’s Patrick Ten Eyck, MS, PhD, assistant director for Biostatistics and Research Design in Iowa’s Institute for Clinical and Translational Science. Other collaborators include Heidi Ahmed, MD, former Iowa internal medicine resident and current gastroenterology fellow at Boston University Medical Center; Natalie Pedersen, MD, another former resident and now internal medicine physician at UnityPoint Clinic Primary Care in Peoria, Illinois; and Manju Bengaluru Jayanna, MD, former UI hospitalist and current cardiology fellow at the Lankenau Institute for Medical Research in Philadelphia.