Magnetic Resonance Elastography (MRE) -Based Prediction Model for Hepatic Decompensation in NAFLD







Platelet Count:



3-Year Risk of Hepatic Decompensation: 

5-Year Risk of Hepatic Decompensation: 

Study Design

Retrospective cohort study with data from six centers from the United States, Europe and Asia:

  • The University of California San Diego
  • Mayo Clinic Rochester
  • Cedars Sinai
  • Musashino Red Cross Hospital
  • Yokohama City University
  • Ankara University School of Medicine

Follow-up time started at the time of the MRE. Participants were followed until development of hepatic decompensation, HCC, death, or the last clinical encounter. Follow-up assessment was performed by a retrospective chart review.

Patient characteristics, including demographic, laboratory, imaging and outcome data are reported as median (interquartile range [IQR]) for continuous variables and N (%) for categorical variables. For the primary outcome, the cohort was randomly split in 1:1 ratio into training and validation sets.

Inclusion and Exclusion Criteria

  • Adults age ≥ 18 years with NAFLD and liver stiffness (LS) measurement by MRE who were assessed for hepatic decompensation, HCC, and death.
  • NAFLD was defined as hepatic steatosis on imaging or a historical liver biopsy in the absence of significant alcohol consumption.


  • Previous history of hepatic decompensation or HCC before enrollment or within 3 months of enrollment, follow-up duration of < 3 months, and incomplete critical laboratory data (Figure 1).

Population Data - Medians

1254 Participants

Training Cohort (n=627)

  • Age: 61 Years
  • BMI: 29.1 kg/m2
  • MRE: 3.5 kPa
  • Average Follow-up: 3 Years

Validation Cohort

  • Age: 60 Years
  • BMI: 28.8 kg/m2
  • MRE: 3.4 kPa
  • Average Follow-up: 4 Years

68 (5.4%) met the composite primary outcome of hepatic decompensation including varices needing treatment, ascites, or hepatic encephalopathy.

Analysis & Results

  • In univariable analysis in the training set, age, DM, ln (MRE), square (albumin), ln (AST), and platelet count were significantly associated with hepatic decompensation
  • In multivariable analysis in the training set, age, ln (MRE), square (albumin), ln (AST), and platelet count met the statistical threshold for inclusion in the multivariable model (p<.10)

Multivariable Model:

S0(t) at 3 Years S0(t) at 5 Years Mean Score Individual Score
0.9681 0.9490 0.059 =0.024(Age) + 0.949ln(MRE) - 0.122(Albumin)2 + 0.734ln(AST) - 0.016(Platelets)

Final Risk Estimation Calculated as: 1 - S0(t)e(Individual Score - Mean Score)

The equation derived in the validation cohort was evaluated in quartiles and stratified the risk of hepatic decompensation in the validation cohort (p<.0001) (Figure 2).

In Context With Published Literature

Strengths and Limitations

  • Large sample size of > 1,200 patients
  • High number of incident hepatic decompensation events (n=68, 5.4%) allowed for adequate power to assess multivariable models in a training and validation cohort
  • First, MRE was only assessed at a single time point in this study. This score was developed to assess prognosis at a single time point and future studies will be required to assess the dynamics of changes in this score over time and its impact on a patients risk of hepatic decompensation
  • Second, primarily because MRE has become available in the clinical practice more recently compared to other NITs, e.g. VCTE or other blood-based markers, our study has a relatively short median follow-up duration.
  • Last, since all patients in the present study belonged to retrospective cohorts at academic medical centers, a subset of clinical events may not have been captured.

Future prospective studies evaluating this MRE-based model with systematic assessment of hepatic decompensation are recommended

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UC San Diego NAFLD Research Center
Altman Clinical and Translational Research Institute
9452 Medical Center Drive La Jolla, CA 92037


Beom Kyung Kim1,2, Jaclyn Bergstrom1, Rohan Loomba1, Nobuharu Tamaki1,5, Namiki Izumi5, Atsushi Nakajima1,6, Ramazan Idilman7, Mesut Gumussoy7, Digdem Kuru Oz8, Ayse Erden8, Emily Truong9, Ju Dong Yang9, Mazen Noureddin9, Alina M. Allen10 and Rohit Loomba1,11, Veeral Ajmera1

1NAFLD Research Center, Division of Gastroenterology. University of California at San Diego, La Jolla, CA, USA 2Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea 3Division of Internal Medicine, Conemaugh Memorial Medical Center, Johnstown, PA, USA 4Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA 5Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital Tokyo, Japan 6Department of Gastroenterology and Hepatology, Yokohama City University, Yokohama, Japan 7Ankara University School of Medicine, Department of Gastroenterology, Ankara Turkey 8Ankara University School of Medicine, Department of Radiology, Ankara Turkey. 9Department of Gastroenterology and Hepatology, Cedars Sinai, Los Angeles, CA, USA 10Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA 11School of Public Health, University of California, San Diego

Copyright © 2023 Justin Yeung