Diagnostic Nomogram Enables Noninvasive Detection of HBV-Related Cirrhosis

A new diagnostic nomogram may allow clinicians to noninvasively diagnose cirrhosis related to chronic hepatitis B virus (HBV) infection based on high-frequency ultrasound and magnetic resonance imaging results.¹

Age, diameter of right hepatic vein, presence or absence of nodules, and liver parenchymal echo grading were identified as independent risk factors for early cirrhosis and used to construct the diagnostic nomogram, which can detect cirrhosis in patients with HBV without liver biopsy and with greater diagnostic accuracy than aspartate aminotransferase to platelet ratio index (APRI), FIB-4, international normalized ratio-to-platelet ratio (INPR), and liver stiffness measurement (LSM).¹

According to the World Health Organization, in 2022, chronic hepatitis B infection affected 254 million people and resulted in an estimated 1.1 million deaths, mostly from cirrhosis and hepatocellular carcinoma.2 A frequent complication of chronic HBV, cirrhosis requires prompt diagnosis and treatment, both of which are frequently hindered by the need for invasive pathological examination with liver biopsy to determine the presence of early cirrhosis.¹

“Currently, various non-invasive liver fibrosis detection technologies and scoring systems have emerged, such as transient elastography, extracellular matrix components (such as hyaluronic acid, type III procollagen peptide, type IV collagen, laminin), APRI, FIB-4, INPR, etc. However, due to interference factors or unsatisfactory accuracy of the results, their clinical value is limited, and they are difficult to be adopted by clinicians,” Yuxia Chen, of Decheng Hospital of Quanzhou in China, and colleagues wrote.¹ “Therefore, a more efficient, non-invasive examination method is urgently needed to replace the pathological examination of liver biopsy.”

To address the unmet need for noninvasive fibrosis detection tools, investigators constructed a diagnostic nomogram based on high-frequency ultrasound and magnetic resonance imaging results. From July 2021 to July 2022, they prospectively enrolled patients with chronic HBV who had undergone liver biopsy. For inclusion, patients were required to be HBsAg positive or HBV DNA positive for ≥ 6 months and have a grade A Child-Pugh liver function score.¹

In total, 72 patients were enrolled in the study, including 43 with early cirrhosis (S4) and 29 without cirrhosis (< S3). Among the cohort, the mean age was 40.5 years and the majority of participants were male (89%).¹

Binary logistic regression analysis revealed age (Odds ratio [OR], 1.14; 95% CI, 1.04–1.27; P = .02), right hepatic vein diameter (OR, 0.43; 95% CI, 0.23–0.82; P = .01), the presence or absence of nodules (OR, 31.98; 95% CI, 3.84–266.08; P <.005), and hepatic parenchymal echogenicity grading (OR, 12.82; 95% CI, 2.12–77.51; P = .01) were independent predictive indicators of HBV-related early cirrhosis. Using the RMS software package of the R software, investigators used these variables to construct a diagnostic nomogram for diagnosing early cirrhosis in patients with chronic HBV.¹

Receiver operating characteristic curve analysis of the diagnostic nomogram showed the AUC was 0.96, the optimal threshold was 0.51, the sensitivity was 0.91, and the specificity was 0.90. The accuracy of the diagnostic model was 0.88, and the corresponding sensitivity, specificity, and 95% CI were 90.70%, 89.66%, and 0.89–0.990, respectively.¹

Investigators noted the nomogram showed greater AUC values than the APRI score (AUC 0.57), FIB-4 score (AUC 0.64), INPR score (AUC 0.63), and LSM score (AUC 0.67), indicating that it outperformed these scoring systems in terms of predictive capability.¹

The C-index of the prediction model was 0.96, and the adjusted C-index calculated by the Bootstrap self-extraction method was 0.94. Investigators drew a calibration curve and noted it appeared to fit well with the ideal curve, indicating the diagnostic nomogram had a good predictive capability for the diagnosis of early liver cirrhosis.¹

Investigators acknowledged multiple limitations to these findings, including the use of Bootstrap self-extraction for validation; the small sample size; and the lack of verification in other chronic liver diseases.¹

“In this prospective study, we constructed a nomogram that showed better diagnostic accuracy in predicting histological cirrhosis. Based on our results, it was found that biopsy can be avoided in low- and high-risk groups,” investigators concluded.¹ “We hope that other researchers may assess the reproducibility of nomograms for noninvasive diagnosis of cirrhosis in independent populations with different clinical backgrounds.”

References

1. ^{Chen Y, Wei M, Chen M, et al. A non-invasive diagnostic nomogram for CHB-related early cirrhosis: a prospective study. Sci Rep. https://doi.org/10.1038/s41598-024-66560-6}
2. ^{World Health Organization. Hepatitis B. Newsroom. April 9, 2024. Accessed July 24, 2024. https://www.who.int/news-room/fact-sheets/detail/hepatitis-b}