Abstract
Abstract
Background
We aimed to formulate a novel predictive nomogram to discriminate liver fibrosis stage in patients with chronic liver disease.
Methods
Nomograms 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.
Results
INR, 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.
Conclusion
The constructed nomograms could be a superior tool for discriminating advanced fibrosis and cirrhosis in chronic liver disease.
Funder
the “13th Five-year” National Science and Technology Major Project of China
Publisher
Springer Science and Business Media LLC
Subject
Gastroenterology,General Medicine
Reference44 articles.
1. D’Amico G, Garcia-Tsao G, Pagliaro L. Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 2006;44(1):217–31.
2. Girleanu I, Trifan A, Singeap AM, Stoica OC, Cojocariu C, Stanciu C. Platelet indices and liver fibrosis evaluation in chronic hepatitis C. Rev Med ChirSoc Med Nat Iasi. 2016;120(1):55–61.
3. Li CJ, Yang ZH, Lu FG, Shi XL, Liu DL. Clinical significance of fibrotic, haemostatic and endotoxic changes in patients with liver cirrhosis. ActaGastroenterolBelg. 2018;81(3):404–9.
4. Imai H, Kamei H, Onishi Y, Ishizu Y, Ishigami M, Goto H, Ogura Y. Diagnostic usefulness of APRI and FIB-4 for the prediction of liver fibrosis after liver transplantation in patients infected with hepatitis C virus. Transplant Proc. 2018;50(5):1431–6.
5. Stockdale AJ, Phillips RO, Geretti AM, Group HS. The gamma-glutamyl transpeptidase to platelet ratio (GPR) shows poor correlation with transient elastography measurements of liver fibrosis in HIV-positive patients with chronic hepatitis B in West Africa. Response to: 'The gamma-glutamyl transpeptidase to platelet ratio (GPR) predicts significant liver fibrosis and cirrhosis in patients with chronic HBV infection in West Africa' by Lemoine et al. Gut. 2016;65(5):882–884.