Chia-Yang Hsu1, Neehar D Parikh2, Teh-Ia Huo3,4, Elliot B Tapper2. 1. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. chiayanghsu2@gmail.com. 2. Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA. 3. Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan. 4. National Yang-Ming University School of Medicine, Taipei, Taiwan.
Abstract
BACKGROUND/AIM: Patients with cirrhosis have poor outcomes once decompensation occurs; however, we lack adequate predictors of decompensation. To use a national claim database to compare the predictive accuracy of seven models for decompensation and hospitalization in patients with compensated cirrhosis. METHODS: We defined decompensation as ascites, hepatic encephalopathy, hepato-renal syndrome, and variceal bleeding. Patients without decompensation at the time of cirrhosis diagnosis were enrolled from 2001 to 2015. Patients with hepatitis B and/or C were grouped as viral cirrhosis. We compared the predictive accuracy of models with the AUC (area under the curve) and c-statistic. The cumulative incidence of decompensation and incidence risk ratios of hospitalization were calculated with the Fine-Gray competing risk and negative binomial models, respectively. RESULTS: A total of 3722 unique patients were enrolled with a mean follow-up time of 524 days. The mean age was 59 (standard deviation 12), and the majority were male (55%) and white (65%). Fifty-three percent of patients had non-viral cirrhosis. Sixteen and 20 percent of patients with non-viral and viral cirrhosis, respectively, developed decompensation (P = 0.589). The FIB-4 model had the highest 3-year AUC (0.73) and overall c-statistic (0.692) in patients with non-viral cirrhosis. The ALBI-FIB-4 model had the best 1-year (AUC = 0.741), 3-year (AUC = 0.754), and overall predictive accuracy (c-statistic = 0.681) in patients with viral cirrhosis. The MELD score had the best predictive power for hospitalization in both non-viral and viral patients. CONCLUSIONS: FIB-4-based models provide more accurate prediction for decompensation, and the MELD model has the best predictive ability of hospitalization.
BACKGROUND/AIM: Patients with cirrhosis have poor outcomes once decompensation occurs; however, we lack adequate predictors of decompensation. To use a national claim database to compare the predictive accuracy of seven models for decompensation and hospitalization in patients with compensated cirrhosis. METHODS: We defined decompensation as ascites, hepatic encephalopathy, hepato-renal syndrome, and variceal bleeding. Patients without decompensation at the time of cirrhosis diagnosis were enrolled from 2001 to 2015. Patients with hepatitis B and/or C were grouped as viral cirrhosis. We compared the predictive accuracy of models with the AUC (area under the curve) and c-statistic. The cumulative incidence of decompensation and incidence risk ratios of hospitalization were calculated with the Fine-Gray competing risk and negative binomial models, respectively. RESULTS: A total of 3722 unique patients were enrolled with a mean follow-up time of 524 days. The mean age was 59 (standard deviation 12), and the majority were male (55%) and white (65%). Fifty-three percent of patients had non-viral cirrhosis. Sixteen and 20 percent of patients with non-viral and viral cirrhosis, respectively, developed decompensation (P = 0.589). The FIB-4 model had the highest 3-year AUC (0.73) and overall c-statistic (0.692) in patients with non-viral cirrhosis. The ALBI-FIB-4 model had the best 1-year (AUC = 0.741), 3-year (AUC = 0.754), and overall predictive accuracy (c-statistic = 0.681) in patients with viral cirrhosis. The MELD score had the best predictive power for hospitalization in both non-viral and viral patients. CONCLUSIONS: FIB-4-based models provide more accurate prediction for decompensation, and the MELD model has the best predictive ability of hospitalization.
Authors: Bryce D Smith; Rebecca L Morgan; Geoff A Beckett; Yngve Falck-Ytter; Deborah Holtzman; Chong-Gee Teo; Amy Jewett; Brittney Baack; David B Rein; Nita Patel; Miriam Alter; Anthony Yartel; John W Ward Journal: MMWR Recomm Rep Date: 2012-08-17