Letter to the Editor: ABIDE in NAFLD: A Potential Game Changer in a Select Cohort of Cirrhosis

Abstract

We read with great interest the study published by Luis Calzadilla-Bertot et al. (1) The study has proposed the ABIDE score, which is a simple bedside tool that aims to predict decompensation in a selected cohort of patients with NAFLD with cirrhosis. However, there are issues that need further clarification.First, with regard to alcohol consumption, the authors need to clarify whether only significant alcohol consumption was excluded or any alcohol consumption either at baseline or at follow-up was excluded. Emerging evidence does indicate that any degree of alcohol consumption not only worsens liver disease status in NAFLD but also increases the risks for type 2 diabetes, which is one of the integral components of the score. (2,3) Similarly, the degree of glycemic control as well as the spectrum of oral antidiabetic use at baseline may further help to substratify the risks in these patients.Second, although the subgroup analysis found no differences with regard to use of baseline betablockers, it would be of interest to know the type and dosage of beta-blocker used at baseline, which may influence the outcomes. (4) Additionally, there appears to be large variations in the rate of decompensation between the derivation and validation cohort (27% vs. 54%). These variations, although not conclusive, are indicative of an inappropriate calibration of the model and raise concerns about the external validation.Third, as the model is derived from a cohort of patients with biopsy-proven NASH, it is important to know whether the patient was receiving medications for NASH cirrhosis. (5) Finally, it is important to note that this model is valid only in NAFLD with cirrhosis; it will be crucial especially to identify patients in this group to target studies with decompensation as the primary endpoint.Future modifications of ABIDE may find its application in the other important NAFLD cohorts.Author Contributions: A.K. was responsible for the draft of the letter. S.T. and A.R. were responsible for the draft and critical revision of the letter. V.S. was responsible for critical revision of the letter.