Abstract
BackgroundWe aimed to formulate a novel predictive nomogram to discriminate liver fibrosis stage in patients with chronic liver disease.MethodsNomograms were established based on the results of multivariate analysis. The predictive accuracy of the nomograms was assessed by ROC analysis and calibration. Decision curve analysis (DCA) was used to determine the clinical benefit of the nomograms.ResultsINR, platelets, and N-terminal propeptide type III collagen (PIIINP) were independent predictors for advanced liver fibrosis (≥ S3) and cirrhosis (S4) in patients with chronic liver disease in the training cohort. In the training set, the areas under the ROCs (AUROCs) of nomogram S3S4, APRI, FIB-4, and GPR for stage ≥ S3 were 0.83, 0.71, 0.68, and 0.74, respectively; the AUROCs of nomogram S4, APRI, FIB-4, and GPR for stage S4 were 0.88, 0.74, 0.78, and 0.79, respectively. The calibrations showed optimal agreement between the prediction by the established nomograms and actual observation. In the validation set, the AUROCs of nomogram S3S4, APRI, FIB-4, and GPR for stage ≥ S3 were 0.86, 0.79, 0.78, and 0.81, respectively; the AUROCs of nomogram S4, APRI, FIB-4, and GPR for stage S4 were 0.88, 0.77, 0.81, and 0.83, respectively. Furthermore, the decision curve analysis suggested that the nomograms represent better clinical benefits in both independent cohorts than APRI, FIB-4, and GPR.ConclusionThe constructed nomograms could be a superior tool for discriminating advanced fibrosis and cirrhosis in chronic liver disease.
Highlights
We aimed to formulate a novel predictive nomogram to discriminate liver fibrosis stage in patients with chronic liver disease
The majority of patients suffered from chronic hepatitis B, and there were no significant differences in various clinical parameters between the training set and validation set
Alanine transaminase (ALT), Aspartate aminotransferase (AST), alkaline phosphatase (ALP), γ-Glutamyl transfetase (GGT), DBil, globulin, total bile acid, international normalized ratio (INR), prothrombin time, APTT, fibrinogen, and thrombin time levels were significantly higher in subjects with fibrosis stages S3-S4 than in subjects with fibrosis stages S0-S2
Summary
We aimed to formulate a novel predictive nomogram to discriminate liver fibrosis stage in patients with chronic liver disease. Chronic liver disease is a major public health problem that accounts for high morbidity and mortality worldwide Their prognosis and treatment depend largely on the progression of liver fibrosis. Blood markers such as platelets and hyaluronic acid have been reported to be related to liver fibrosis [2, 3] Serological markers such as the aspartate transaminase to platelet ratio (APRI), fibrosis-4 score (FIB-4), and γ-glutamyl transpeptidase to platelet ratio (GPR) have been used to assess liver fibrosis and have been reported to be effective [4,5,6]. Other potential mingle factors may affect the accuracy of TE, such as obesity, increased transaminase, and operator skills [13]
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