Develop and validate a novel online AIHI-nomogram to predict severe liver inflammation in patients with autoimmune hepatitis

• Published in: Annals of hepatology Vol. 28; no. 6; p. 101134
• Main Authors: Zhang, Zhiyi, Wang, Jian, Wang, Huali, Li, Yiguang, Zhu, Li, Chen, Yun, Liu, Jiacheng, Liu, Yilin, Chen, Yuxin, Yin, Shengxia, Tong, Xin, Yan, Xiaomin, Yang, Yongfeng, Zhu, Chuanwu, Li, Jie, Qiu, Yuanwang, Huang, Rui, Wu, Chao
• Format: Journal Article
• Language: English
• Published: Mexico Elsevier 01-11-2023
• Subjects: Adult; Aged; Autoimmune hepatitis; Bilirubin - blood; Biomarkers - blood; Biopsy; Female; gamma-Glutamyltransferase - blood; Hepatitis, Autoimmune - blood; Hepatitis, Autoimmune - complications; Hepatitis, Autoimmune - diagnosis; Humans; Liver - pathology; Liver inflammation; Male; Middle Aged; Nomograms; Prediction model; Predictive Value of Tests; Reproducibility of Results; Retrospective Studies; ROC Curve; Severity of Illness Index; Liver inflammation; Autoimmune hepatitis; Prediction model
• ISSN: 1665-2681
• DOI: 10.1016/j.aohep.2023.101134

Assessment of liver inflammation plays a vital role in the management of patients with autoimmune hepatitis (AIH). We aimed to establish and validate a nomogram to predict severe liver inflammation in AIH patients.
AIH patients who underwent liver biopsy were included and randomly divided into a training set and a validation set. Independent predictors of severe liver inflammation were selected by the least absolute shrinkage and selection operator regression from the training set and used to conduct a nomogram. Receiver characteristic curves (ROC), calibration curves, and decision curve analysis (DCA) were adopted to evaluate the performance of nomogram.
Of the 213 patients, female patients accounted for 83.1% and the median age was 53.0 years. The albumin, gamma-glutamyl transpeptidase, total bilirubin, red cell distribution width, prothrombin time, and platelets were independent predictors of severe inflammation. An online AIHI-nomogram was established and was available at https://ndth-zzy.shinyapps.io/AIHI-nomogram/. The calibration curve revealed that the AIHI-nomogram had a good agreement with actual observation in the training and validation sets. The area under the ROCs of AIHI-nomogram were 0.795 in the training set and 0.759 in the validation set, showing significantly better performance than alanine aminotransferase and immunoglobulin G in the training and validation sets, as well in AIH patients with normal ALT in the training set. DCA indicated that the AIHI-nomogram was clinically useful.
This novel AIHI-nomogram provided an excellent prediction of severe liver inflammation in AIH patients and could be used for the better management of AIH.