Development and validation of a clinical and laboratory-based nomogram to predict nonalcoholic fatty liver disease
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ORIGINAL ARTICLE
Development and validation of a clinical and laboratory‑based nomogram to predict nonalcoholic fatty liver disease Chao Cen1 · Wenpu Wang2 · Songfeng Yu1 · Xiaofeng Tang1 · Jimin Liu3 · Yuanxing Liu1 · Lin Zhou1 · Jun Yu1 · Shusen Zheng1 Received: 12 January 2020 / Accepted: 6 June 2020 © Asian Pacific Association for the Study of the Liver 2020
Abstract Background and aim Nonalcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease in China. The early identification and management of patients at risk are essential. We aimed to develop a novel clinical and laboratory-based nomogram (CLN) model to predict NAFLD with high accuracy. Methods We designed a retrospective cross-sectional study and enrolled 21,468 participants (16,468 testing and 5000 validation). Clinical information and laboratory/imaging results were retrieved. Significant variables independently associated with NAFLD were identified by a logistic regression model, and a NAFLD prediction CLN was constructed. The CLN was then compared with four existing NAFLD-related prediction models: the fatty liver index (FLI), the hepatic steatosis index (HSI), the visceral adiposity index (VAI) and the triglycerides and glucose (TyG) index. Area under the receiver operator characteristic curve (AUROC) and decision curve analysis (DCA) were performed. Results A total of 6261/16,468 (38.02%) and 1759/5000 (35.18%) participants in the testing and validation datasets, respectively, had ultrasound-proven NAFLD. Six variables were selected to build the CLN: body mass index (BMI), diastolic blood pressure (DBP), uric acid (UA), fasting blood glucose (FBG), triglyceride (TG), and alanine aminotransferase (ALT). The diagnostic accuracy of the CLN for NAFLD (AUROC 0.857, 95% CI 0.852–0.863) was significantly superior to that of the FLI (AUROC 0.849, 95% CI 0.843–0.855), the VAI (AUROC 0.752, 95% CI 0.745–0.760), the HSI (AUROC 0.828, 95% CI 0.822–0.834), and the TyG index (AUROC 0.774, 95% CI 0.767–0.781) (all p 140 g/week for men and 70 g/week for women; (3) those with a history of other known causes of chronic liver disease such as viral hepatitis or autoimmune hepatitis; and (4) those using hepatotoxic medications (e.g., sulfonamides and azithromycin). A total of 16,468 participants from 2014 were included in the training dataset, while 5000 participants from 2016 were assigned to the validation dataset. The personal information of each participant was anonymized at collection prior to analysis. The study was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine.
Clinical information and questionnaire The study data included five parts: medical history, questionnaire, anthropometric and blood biochemical measurements, and image studies. All medical histories, including current/ previous diseases and drug prescriptions, were assessed by the examining physicians. Questions about alcohol intake included the frequency of weekly alcohol consumption and the usual a
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