Department of Infectious Diseases, Shunde Hospital of Southern Medical University, Shunde, Guangdong, China.
Sci Rep. 2017 Dec 13;7(1):17493. doi: 10.1038/s41598-017-17685-4.
The aim of this retrospective study was to establish a simple self-assessed scale for individual risk of cirrhosis in patients with chronic hepatitis B. A total of 1808 consecutive patients were enrolled and analyzed. According to the results of multivariate logistic regression analysis, a simple nomogram was calculated for cirrhosis. The area under receiver operating characteristic curves (AUROCs) were calculated to compare the diagnostic accuracy of nomogram with aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on the four factors (FIB-4), and S index. The AUROCs of nomogram for cirrhosis were 0.807 (adjusted AUROC 0.876) in model group and 0.794 (adjusted AUROC0.866) in validation group. DeLong's test and Brier Score further demonstrated that nomogram was superior to APRI, FIB-4 and S index in both model group and validation group. The patients with nomogram <0.07 could be defined as low risk group with cirrhosis prevalence lower than 4.3% (17/397). The patients with nomogram >0.52 could be defined as high risk group with cirrhosis prevalence higher than 73.0% (119/163). In conclusion, as a self-assessed style, simple, non-invasive, economical, convenient, and repeatable scale, nomogram is suitable to serve as a massive health screening tool for cirrhosis in CHB patients and further external validation is needed.
本回顾性研究旨在为慢性乙型肝炎患者建立一种简单的个体肝硬化风险自评量表。共纳入并分析了 1808 例连续患者。根据多变量逻辑回归分析的结果，为肝硬化计算了一个简单的列线图。计算了接受者操作特征曲线（AUROCs）的面积，以比较列线图与天冬氨酸氨基转移酶血小板比值指数（APRI）、基于四个因素的纤维化指数（FIB-4）和 S 指数的诊断准确性。模型组和验证组列线图对肝硬化的 AUROCs 分别为 0.807（调整后的 AUROC 为 0.876）和 0.794（调整后的 AUROC 为 0.866）。DeLong 检验和 Brier 评分进一步表明，在模型组和验证组中，列线图均优于 APRI、FIB-4 和 S 指数。列线图<0.07 的患者可定义为肝硬化患病率低于 4.3%（17/397）的低危组。列线图>0.52 的患者可定义为肝硬化患病率高于 73.0%（119/163）的高危组。总之，作为一种自评式、简单、非侵入性、经济、方便、可重复的量表，列线图适合作为 CHB 患者肝硬化的大规模健康筛查工具，还需要进一步的外部验证。
