Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov;34(11):e23501.
doi: 10.1002/jcla.23501. Epub 2020 Sep 11.

A nomogram based on pretreatment clinical parameters for the prediction of inadequate biochemical response in primary biliary cholangitis

Siyuan Tian  1 , Yansheng Liu  1 , Keshuai Sun  1 , Xia Zhou  1 , Shuoyi Ma  1 , Miao Zhang  1 , Xinmin Zhou  1 , Lu Wang  1   2 , Ying Han  1
Affiliations

A nomogram based on pretreatment clinical parameters for the prediction of inadequate biochemical response in primary biliary cholangitis

Siyuan Tian et al. J Clin Lab Anal. 2020 Nov.

Abstract

Background: Ursodeoxycholic acid (UDCA) has been widely recommended as the first-line drug for primary biliary cholangitis (PBC) in the current guidelines. However, its therapeutic effects are poor in nearly one-third of patients. The early identification and intervention of these patients is crucial for delaying disease progression. Therefore, we explored risk factors for inadequate biochemical response and constructed a nomogram to predict the potential risk.

Methods: We enrolled 356 patients and randomly divided them into training (70%) and validation groups (30%). We defined inadequate biochemical response as the study endpoint. Logistic analysis was used to identify the independent predictors of poor biochemical response. Based on these factors, a predictive nomogram was finally constructed. Then, discrimination and calibration were evaluated by internal validation. Additionally, the association between the model predictions and prognosis was further analyzed.

Results: Female sex, and albumin and bilirubin concentrations were identified as risk factors, and a nomogram was built based on these factors. The areas under the ROC curves of the training and validation groups were 0.809 and 0.791, respectively. Moreover, calibration curves showed that predictions of the nomogram had good concordance with the actual outcomes. The correlation analysis demonstrated that PBC patients with a high probability of a suboptimal biochemical response were more likely to have adverse outcomes.

Conclusion: We constructed a nomogram, which can accurately predict the risk of inadequate biochemical response to UDCA, facilitating the early screening of high-risk patients with PBC who should be prioritized for additional therapy.

Keywords: autoimmune liver disease; biochemical response; nomogram; primary biliary cholangitis; ursodeoxycholic acid.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Nomogram to predict the probability of inadequate biochemical response to ursodeoxycholic acid in PBC patients. ALB, albumin; LLN, lower limit of normal; TBiL, total bilirubin; ULN; upper limit of normal
Figure 2
Figure 2
Receiver operating characteristic (ROC) curves for the predictive model. A, ROC curve in the training group. B, ROC curve in the validation group. (AUC, area under the ROC curve)
Figure 3
Figure 3
Calibration curves for the predictive model. A, Calibration curve in the training group (χ2 = 14.539, P > .05). B, Calibration curve in the validation group (χ2 = 4.526, P > .05)
Figure 4
Figure 4
Correlations between the nomogram predictions and long‐term prognosis. A, B, and C, Correlations between the probability of inadequate biochemical response and the predicted liver transplant‐free survival by the GLOBE score. (D, E, and F) Correlations between the probability of inadequate biochemical response and the predicted risk of liver transplant or death by the UK‐PBC risk scores
See this image and copyright information in PMC

References

    1. Gulamhusein AF, Hirschfield GM. Primary biliary cholangitis: pathogenesis and therapeutic opportunities. Nat Rev Gastroenterol Hepatol. 2020;17(2):93‐110. - PubMed
    1. Carey EJ, Ali AH, Lindor KD. Primary biliary cirrhosis. Lancet. 2015;386(10003):1565‐1575. - PubMed
    1. Beuers U, Gershwin EM, Gish RG, et al. Changing nomenclature for PBC: from 'Cirrhosis' to 'Cholangitis'. Am J Gastroenterol. 2015;110(11):1536‐1538. - PMC - PubMed
    1. Corpechot C, Carrat F, Bahr A, Chrétien Y, Poupon R‐E, Poupon R. The effect of ursodeoxycholic acid therapy on the natural course of primary biliary cirrhosis. Gastroenterology. 2005;128(2):297‐303. - PubMed
    1. Corpechot C, Abenavoli L, Rabahi N, et al. Biochemical response to ursodeoxycholic acid and long‐term prognosis in primary biliary cirrhosis. Hepatology. 2008;48(3):871‐877. - PubMed

Substances