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非酒精性脂肪性肝病患者慢性肾脏病检测列线图的构建与验证:来自美国国家健康与营养检查调查(NHANES)数据库的见解

Construction and validation of a nomogram for detecting chronic kidney disease in patients with nonalcoholic fatty liver disease: Insights from the NHANES database.

作者信息

Deng Dazhang, Xie Yutong, Wang Ya, Song Wanhan, Liu Yuguo, Liu Bin, Guo Honghui

机构信息

Department of Nutrition, School of Public Health, Guangdong Medical University, Dongguan, PR China; Laboratory of Hepatobiliary Surgery, the Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, PR China.

Department of Nutrition, School of Public Health, Guangdong Medical University, Dongguan, PR China.

出版信息

Clinics (Sao Paulo). 2025 May 7;80:100686. doi: 10.1016/j.clinsp.2025.100686. eCollection 2025.

Abstract

BACKGROUND AND OBJECTIVES

Fatty liver disease is often associated with renal impairment in many patients. Early detection and prompt intervention are crucial for improving patient quality of life and reducing mortality rates. This study aimed to develop and validate a nomogram for detecting the risk of Chronic Kidney Disease (CKD) comorbidity in adults with Nonalcoholic Fatty Liver Disease (NAFLD) in the United States.

METHODS

From the NHANES (2017‒2020) database, the authors enrolled 2848 NAFLD participants, of whom 633 also had CKD. The authors employed the Least Absolute Shrinkage and Selection Operator (LASSO) regression and multivariate logistic regression to identify variables with predictive value. The overlapping features were selected to construct a predictive model, which was presented as a nomogram. The effectiveness of the nomogram was evaluated using Receiver Operating Characteristic (ROC) curves, calibration plots, and decision curve analysis.

RESULTS

Six indicators were included in the model: age, systolic blood pressure, serum albumin, high-sensitivity C-reactive protein, total cholesterol, and triglycerides. The area under the curve of the nomogram for predicting CKD in the training set was 0.772, with a 95 % Confidence Interval (95 % CI) of 0.746 to 0.797. In the validation set, the area under the curve was 0.722, with a 95 % CI of 0.680 to 0.763. The calibration curve analyses demonstrated that the prediction outcomes of the model aligned well with the actual outcomes, indicating good clinical applicability.

CONCLUSIONS

The nomogram demonstrated excellent performance and has the potential to serve as an auxiliary tool for detecting CKD in NAFLD patients.

摘要

背景与目的

在许多患者中,脂肪肝疾病常与肾功能损害相关。早期发现和及时干预对于改善患者生活质量及降低死亡率至关重要。本研究旨在开发并验证一种列线图,用于检测美国非酒精性脂肪性肝病(NAFLD)成人患者合并慢性肾脏病(CKD)的风险。

方法

作者从美国国家健康与营养检查调查(NHANES,2017 - 2020)数据库中纳入了2848名NAFLD参与者,其中633人同时患有CKD。作者采用最小绝对收缩和选择算子(LASSO)回归及多因素逻辑回归来识别具有预测价值的变量。选择重叠特征构建预测模型,并将其呈现为列线图。使用受试者工作特征(ROC)曲线、校准图和决策曲线分析来评估列线图的有效性。

结果

该模型纳入了六个指标:年龄、收缩压、血清白蛋白、高敏C反应蛋白、总胆固醇和甘油三酯。训练集中预测CKD的列线图曲线下面积为0.772,95%置信区间(95%CI)为0.746至0.797。在验证集中,曲线下面积为0.722,95%CI为0.680至0.763。校准曲线分析表明,该模型的预测结果与实际结果吻合良好,具有良好的临床适用性。

结论

该列线图表现出色,有潜力作为检测NAFLD患者CKD的辅助工具。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/a756/12133694/d8878750cfe6/gr1.jpg

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