Background. Preventing liver fibrosis from progressing to cirrhosis and even liver cancer is a key step in the treatment of chronic hepatitis B (CHB). This study is aimed at constructing and validating a new nomogram for predicting significant liver fibrosis () in CHB patients. Methods. The nomogram was based on a retrospective study of 252 CHB patients. The predictive accuracy and discriminative ability of the nomogram were evaluated by the area under receiver operating characteristic curve (AUROC), decision curves, and calibration curve compared with the fibrosis 4 score (FIB-4) and aspartate aminotransferase-to-platelet ratio index (APRI). The results were validated using bootstrap resampling and an external set of 168 CHB patients. Results. A total of 420 CHB patients were enrolled based on liver biopsy results. Independent factors predicting significant liver fibrosis were laminin (LN), procollagen type III N-terminal peptide (PIIINP), and blood platelet count (PLT) in a multivariate analysis, and these factors were selected to construct the nomogram. The calibration curve for the probability of significant liver fibrosis showed optimal agreement between the prediction from the nomogram and actual observation. The prediction from the nomogram was more consistent with the results of liver biopsy than FIB-4 and APRI. The AUROC of the nomogram was higher than that of FIB-4 and APRI for predicting significant liver fibrosis. These results were confirmed in the validation set. Furthermore, the decision curve analysis suggested that the most net benefits were provided by the nomogram. Conclusions. We found the proposed nomogram resulted in a more accurate prediction of significant liver fibrosis in CHB patients and could provide the most net benefits. We recommend this noninvasive assessment for patients with liver fibrosis to avoid the risk of liver biopsy and earlier intervention to prevent the development of cirrhosis or liver cancer.

中文翻译：

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慢性乙型肝炎患者显着肝纤维化的新预测模型。

背景。防止肝纤维化发展为肝硬化甚至肝癌是治疗慢性乙型肝炎（CHB）的关键步骤。本研究旨在构建和验证用于预测显着肝纤维化的新列线图。)在慢性乙型肝炎患者中。方法。列线图基于对 252 名慢性乙型肝炎患者的回顾性研究。列线图的预测准确性和判别能力通过受试者工作特征曲线下面积（AUROC）、决策曲线和校准曲线与纤维化 4 评分（FIB-4）和天冬氨酸氨基转移酶与血小板比率指数进行比较来评估。 APRI)。使用自举重采样和外部一组 168 名 CHB 患者验证了结果。结果. 根据肝活检结果，共招募了 420 名 CHB 患者。多变量分析中预测显着肝纤维化的独立因素为层粘连蛋白（LN）、前胶原III型N末端肽（PIIINP）和血小板计数（PLT），并选择这些因素构建列线图。显着肝纤维化概率的校准曲线显示列线图的预测与实际观察之间的最佳一致性。列线图的预测与肝活检结果比 FIB-4 和 APRI 更一致。列线图的 AUROC 在预测显着肝纤维化方面高于 FIB-4 和 APRI。这些结果在验证集中得到了证实。此外，决策曲线分析表明，列线图提供了最大的净收益。结论。我们发现所提出的列线图可以更准确地预测慢性乙型肝炎患者的显着肝纤维化，并且可以提供最大的净收益。我们建议对肝纤维化患者进行这种无创评估，以避免肝活检的风险和早期干预以预防肝硬化或肝癌的发展。