A Novel Prediction Model for Significant Liver Fibrosis in Patients with Chronic Hepatitis B.

Yaqiong Chen,Wenying Zhou,Yutian Chong,Jiao Gong,Yusheng Jie,Zhaoxia Li,Bo Hu

doi:10.1155/2020/6839137

Abstract

Background Preventing liver fibrosis from progressing to cirrhosis and even liver cancer is a key step in the treatment of chronic hepatitis B (CHB). This study is aimed at constructing and validating a new nomogram for predicting significant liver fibrosis (S ≥ 2) in CHB patients. Methods The nomogram was based on a retrospective study of 252 CHB patients. The predictive accuracy and discriminative ability of the nomogram were evaluated by the area under receiver operating characteristic curve (AUROC), decision curves, and calibration curve compared with the fibrosis 4 score (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI). The results were validated using bootstrap resampling and an external set of 168 CHB patients. Results A total of 420 CHB patients were enrolled based on liver biopsy results. Independent factors predicting significant liver fibrosis were laminin (LN), procollagen type III N-terminal peptide (PIIINP), and blood platelet count (PLT) in a multivariate analysis, and these factors were selected to construct the nomogram. The calibration curve for the probability of significant liver fibrosis showed optimal agreement between the prediction from the nomogram and actual observation. The prediction from the nomogram was more consistent with the results of liver biopsy than FIB-4 and APRI. The AUROC of the nomogram was higher than that of FIB-4 and APRI for predicting significant liver fibrosis. These results were confirmed in the validation set. Furthermore, the decision curve analysis suggested that the most net benefits were provided by the nomogram. Conclusions We found the proposed nomogram resulted in a more accurate prediction of significant liver fibrosis in CHB patients and could provide the most net benefits. We recommend this noninvasive assessment for patients with liver fibrosis to avoid the risk of liver biopsy and earlier intervention to prevent the development of cirrhosis or liver cancer.

Highlights

In China, chronic hepatitis B (CHB) is the primary cause of liver-related morbidity and mortality
Chronic hepatitis has been shown to lead to liver fibrosis, which may progress to liver cirrhosis, end-stage liver disease, and liver cancer [1]
Our results demonstrated that our nomogram, comprising platelet count (PLT), LN, and procollagen type III N-terminal peptide (PIIINP), was more consistent with the observed results from liver biopsies and outperformed fibrosis 4 score (FIB-4) and aminotransferase-to-platelet ratio index (APRI) in diagnosing significant liver fibrosis (S ≥ 2) in CHB patients

Summary

Introduction

In China, CHB is the primary cause of liver-related morbidity and mortality. Chronic hepatitis has been shown to lead to liver fibrosis, which may progress to liver cirrhosis, end-stage liver disease, and liver cancer [1]. It is of great importance to find an inexpensive and more accurate scoring system for the early prediction and risk assessment of liver fibrosis stages in CHB patients, as it could potentially prevent the progression of HBVrelated diseases. The AUROC of the nomogram was higher than that of FIB-4 and APRI for predicting significant liver fibrosis These results were confirmed in the validation set. We found the proposed nomogram resulted in a more accurate prediction of significant liver fibrosis in CHB patients and could provide the most net benefits. We recommend this noninvasive assessment for patients with liver fibrosis to avoid the risk of liver biopsy and earlier intervention to prevent the development of cirrhosis or liver cancer

Objectives

Methods

Conclusion