Identification of clinical phenotypes associated with poor prognosis in patients with nonalcoholic fatty liver disease via unsupervised machine learning.
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Ito Takanori, Morooka Hikaru, Takahashi Hirokazu, Fujii Hideki, Iwaki Michihiro, Hayashi Hideki, Toyoda Hidenori, Oeda Satoshi, Hyogo Hideyuki, Kawanaka Miwa, Morishita Asahiro, Munekage Kensuke, Kawata Kazuhito, Tsutsumi Tsubasa, Sawada Koji, Maeshiro Tatsuji, Tobita Hiroshi, Yoshida Yuichi, Naito Masafumi, Araki Asuka, Arakaki Shingo, Kawaguchi Takumi, Noritake Hidenao, Ono Masafumi, Masaki Tsutomu, Yasuda Satoshi, Tomita Eiichi, Yoneda Masato, Tokushige Akihiro, Ishigami Masatoshi, Kamada Yoshihiro, Ueda Shinichiro, Aishima Shinichi, Sumida Yoshio, Nakajima Atsushi, Okanoue Takeshi, Japan Study Group of Nonalcoholic Fatty Liver Disease (JSG-NAFLD)
Аннотация
METHODS: We conducted a multicenter study of 1335 biopsy-proven NAFLD patients from Japan. Using the Gaussian mixture model to divide the cohort into clusters based on FIB-4 index and BMI, we investigated prognosis for these clusters.
RESULTS: The cohort consisted of 223 cases (16.0%) with advanced fibrosis (F3-4) as assessed from liver biopsy. Median values of BMI and FIB-4 index were 27.3 kg/m2 and 1.67. The patients were divided into four clusters by Bayesian information criterion, and all-cause mortality was highest in cluster d, followed by cluster b (P = 0.001). Regarding the characteristics of each cluster, clusters d and b presented a high FIB-4 index (median 5.23 and 2.23), cluster a presented the lowest FIB-4 index (median 0.78), and cluster c was associated with moderate FIB-4 level (median 1.30) and highest BMI (median 34.3 kg/m2 ). Clusters a and c had lower mortality rates than clusters b and d. However, all-cause of death in clusters a and c was unrelated to liver disease.
CONCLUSIONS: Our clustering approach found that the FIB-4 index is an important predictor of mortality in NAFLD patients regardless of BMI. Additionally, non-liver-related diseases were identified as the causes of death in NAFLD patients with low FIB-4 index.