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Validation of a model for identification of patients with compensated cirrhosis at high risk of decompensation

Guha, I.N.; Harris, R.; Berhane, S.; Dillon, A.; Coffey, L.; James, M.W.; Cucchetti, A.; Harman, D.J.; Aithal, G.P.; Elshaarawy, O.; Waked, I.; Stewart, S.; Johnson, P.J.


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Professor of Hepatology

Clinical Assistant Professor

S. Berhane

A. Dillon

L. Coffey

M.W. James

A. Cucchetti

D.J. Harman

O. Elshaarawy

I. Waked

S. Stewart

P.J. Johnson


Background & Aims: 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.
Methods: 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.
Results: 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.
Conclusion: 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.


Guha, I., Harris, R., Berhane, S., Dillon, A., Coffey, L., James, M., …Johnson, P. (2019). Validation of a model for identification of patients with compensated cirrhosis at high risk of decompensation. Clinical Gastroenterology and Hepatology, 17(11), 2330-2338.e1.

Journal Article Type Article
Acceptance Date Jan 28, 2019
Online Publication Date Feb 1, 2019
Publication Date 2019-10
Deposit Date Jan 29, 2019
Publicly Available Date Feb 2, 2020
Journal Clinical Gastroenterology and Hepatology
Print ISSN 1542-3565
Electronic ISSN 1542-7714
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 17
Issue 11
Pages 2330-2338.e1
Keywords liver failure, prognostic factor, alcohol-associated liver disease outcome, NAFLD prediction
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