{'fraction_non_alphanumeric': 0.026286353467561523, 'fraction_numerical': 0.011185682326621925, 'mean_word_length': 5.255244755244755, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 1, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
The natural history of advanced chronic liver disease defined by transient elastography.

BACKGROUND AND AIMS
The clinical course of cirrhosis does not follow a predictable trajectory. Transient elastography (TE) is commonly used in clinical practice to diagnose liver fibrosis and increasingly to risk stratify patients. The aim of this study was to assess the natural history of advanced chronic liver disease (ACLD) defined by TE using electronic health record (EHR) data in a multistate framework.


METHODS
TE data was collected between 2008 and 2019. Patients with a liver stiffness measurement (LSM) of >10kPa were included. Disease and procedure code information held in EHR was analysed. Clinical events including decompensation, hepatocellular carcinoma, and death were identified. Outcomes were described in a multistate model using flexible parametric survival methods including LSM and the albumin bilirubin (ALBI) score.


RESULTS
3028 patients were included. Median follow up was 3.1 years. LSM and ALBI were associated with the development of varices and decompensation, and ALBI, age, sex, and viral liver disease were associated with the development of hepatocellular carcinoma from the compensated state. The cumulative incidence of HCC before decompensation was low for patients with alcohol related liver disease (3.8%) and nonalcoholic fatty liver disease (1.3%) at five years after TE. Importantly, death was predicted to occur before decompensation or HCC in most cases.


CONCLUSIONS
Liver stiffness, ALBI score, and disease aetiology are each associated with outcomes in a large contemporary cohort with ACLD. EHR data can be used to define clinical progression in these patients, facilitating large clinical effectiveness trials and cost-effectiveness analyses.