A novel web-based online nomogram to predict advanced liver fibrosis in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome

Zhiyi Zhang; Jian Wang; Yun Chen; Yiguang Li; Li Zhu; Huali Wang; Yilin Liu; Jiacheng Liu; Shengxia Yin; Xin Tong; Xiaomin Yan; Yuxin Chen; Chuanwu Zhu; Jie Li; Yuanwang Qiu; Chao Wu; Rui Huang

doi:10.1016/j.jtauto.2023.100215

A novel web-based online nomogram to predict advanced liver fibrosis in patients with autoimmune hepatitis-primary biliary cholangitis overlap syndrome

J Transl Autoimmun. 2023 Oct 14:7:100215. doi: 10.1016/j.jtauto.2023.100215. eCollection 2023 Dec.

Authors

Zhiyi Zhang¹, Jian Wang^{2

3}, Yun Chen⁴, Yiguang Li⁵, Li Zhu⁶, Huali Wang⁷, Yilin Liu¹, Jiacheng Liu², Shengxia Yin², Xin Tong², Xiaomin Yan², Yuxin Chen^{3

8}, Chuanwu Zhu⁶, Jie Li^{1

2

3

4}, Yuanwang Qiu⁵, Chao Wu^{1

2

3

4}, Rui Huang^{1

2

3

4}

Affiliations

¹ Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
² Department of Infectious Diseases, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.
³ Institute of Viruses and Infectious Diseases, Nanjing University, Nanjing, Jiangsu, China.
⁴ Department of Infectious Diseases, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.
⁵ Department of Infectious Diseases, The Fifth People's Hospital of Wuxi, Wuxi, Jiangsu, China.
⁶ Department of Infectious Diseases, The Affiliated Infectious Diseases Hospital of Soochow University, Suzhou, Jiangsu, China.
⁷ Department of General Practice, Nanjing Second Hospital, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
⁸ Department of Laboratory Medicine, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, Jiangsu, China.

Abstract

Background: Patients with autoimmune hepatitis-primary biliary cholangitis (AIH-PBC) overlap syndrome have a worse prognosis compared to AIH or PBC alone and accurately predicting the severity and dynamically monitoring the progression of disease are therefore essential. We aimed to develop a nomogram-based model to predict advanced liver fibrosis in patients with AIH-PBC overlap syndrome.

Methods: A total of 121 patients with AIH-PBC overlap syndrome were retrospectively included and randomly assigned to a development set and a validation set. Backward stepwise regression's best model with the lowest AIC was employed to create a nomogram. Diagnose accuracy was evaluated using the area under the receiver operator characteristic curve (AUROC), calibration analysis, and decision curve analysis (DCA) and was compared with aspartate aminotransferase-to-platelet ratio (APRI) and fibrosis index based on four factors-4 (FIB-4) score.

Results: The median age of patients was 53.0 years (IQR: 46.0-63.0), and female patients accounted for 95.0 %. Platelets, globulin, total bilirubin, and prothrombin time were associated with advanced fibrosis (≥S3) and used to construct an AIH-PBC overlap syndrome fibrosis (APOSF)-nomogram (available online at https://ndth-zzy.shinyapps.io/APOSF-nomogram/). The AUROCs of APOSF-nomogram were 0.845 (95 % CI: 0.754-0.936) and 0.843 (95 % CI: 0.705-0.982) in development set and validation set respectively, which was significantly better than APRI and FIB-4. Calibration revealed that the estimated risk fits well with biopsy-proven observation. DCA outperformed APRI and FIB4 in terms of net benefit, demonstrating clinical utility.

Conclusion: This novel non-invasive web-based online APOSF-nomogram provided a convenient tool for identifying advanced fibrosis in patients with AIH-PBC overlap syndrome. Further prospective, multicenter studies with large sample size are necessary to validate the applicability of APOSF-nomogram.

Keywords: Autoimmune hepatitis; Biopsy; Liver fibrosis; Nomogram; Non-invasive test; Overlap syndrome; Primary biliary cholangitis.