Analysis of risk factors for liver fibrosis in metabolic dysfunction-associated fatty liver disease and construction of a nomogram

doi:10.3969/j.issn.1004-583X.2025.05.006

Abstract

Abstract:

Objective To explore the related risk factors for the occurrence of liver fibrosis in metabolic dysfunction-associated fatty liver disease (MAFLD), and to construct a nomogram to predict liver fibrosis. Methods Demographic data and blood biochemical indicators of MAFLD patients were retrospectively collected. Liver fibrosis was determined by the liver stiffness measure (LSM) detected via FibroScan. Logistic regression analysis was conducted to identify potential predictive indicators for liver fibrosis in MAFLD, and a nomogram was then created. The discrimination ability, consistency, and clinical applicability of the nomogram were assessed through C-index, calibration plots, and decision curves, respectively. Results A total of 282 MAFLD patients were included. Among them, 97 patients had liver fibrosis (LSM≥8 kPa), and 185 patients did not have liver fibrosis (LSM<8 kPa). Univariate analysis indicated that platelet count (PLT), platelet-to-white blood cell ratio (PWR), alkaline phosphatase (ALP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT), serum uric acid (UA), and homocysteine (HCY) were influencing factors for liver fibrosis in MAFLD patients (P<0.05). The multivariate Logistic regression analysis revealed that the PWR (OR=0.921, 95%CI: 0.877-0.967, P<0.001) was a protective factor for liver fibrosis, HCY(OR=1.101, 95%CI: 1.032-1.175, P=0.003), AST(OR=1.021, 95%CI: 1.011-1.031, P<0.001), and UA(OR=1.032, 95%CI: 1.001-1.066, P=0.048) were independent risk factors for liver fibrosis in MAFLD patients. The nomogram constructed based on these factors had good discrimination (area under the curve [AUC]=0.835, 95%CI: 0.779-0.891), and the calibration curve indicated that the predicted probability of liver fibrosis was highly consistent with the observed probability. The clinical decision curve determined that the nomogram had a high net benefit within the threshold probability range. Conclusion The nomogram constructed based on PWR, HCY, AST and UA can well predict the risk of liver fibrosis in MAFLD patients, thereby enabling early identification and intervention. It has high clinical application value.

Key words: non-alcoholic fatty liver disease, metabolic dysfunction-associated fatty liver disease, liver fibrosis, nomogram, risk factors

CLC Number:

R575.5

Zhao Xueting, Bai Jiawen, Sun Jun. Analysis of risk factors for liver fibrosis in metabolic dysfunction-associated fatty liver disease and construction of a nomogram[J]. Clinical Focus, 2025, 40(5): 417-422.

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URL: http://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.05.006

http://www.lchc.cn/EN/Y2025/V40/I5/417

Figures/Tables 7

References 21

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组别			例数	年龄 (岁)			性别[例(%)]						BMI[例(%)]								高血压病 [例(%)]	吸烟史 [例(%)]		饮酒史 [例(%)]
组别			例数	年龄 (岁)			男性			女性			正常			超重			肥胖		高血压病 [例(%)]	吸烟史 [例(%)]		饮酒史 [例(%)]
训练集			199	53(42,61)			122.0(61.3)			77.0(38.7)			37(18.6)			67(33.7)			95(47.7)		87(43.7)	63(31.7)		28(14.1)
验证集			83	50(40,60)			43.0(51.8)			40.0(48.2)			15(18.1)			29(34.9)			39(47.7)		31(37.3)	17(20.5)		5(6.02)
χ²/Z值				-0.502			2.177						0.043								0.976	3.600		3.670
P值				0.615			0.140						0.979								0.323	0.058		0.055
组别	HOMA-IR					FPG (mmol/L)			HbA₁c (%)			UA (mmol/L)			WBC (×10⁹/L)			PLT (×10⁹/L)		PWR		ALB (g/L)		ALT (IU/L)
训练集	7.86(4.4,13.8)					9.88(7.10, 13.5)			8.1(6.7, 9.6)			367(300,453)			7.5(6.14,9.05)			231(200,275)		28.98(24.62,36.9)		45(42,47)		44(27,78)
验证集	5.83(4.27, 10.38)					8.72(6.75, 12.76)			7.8(6.4, 9.6)			350(326,435)			7.36(5.89,8.6)			236(211,282)		34.0(41.0,47.0)		45(41,47)		55(29,83)
χ²/Z值	-1.938					-1.345			-0.944			-0.004			-1.122			-0.863		-2.351		-0.438		-0.758
P值	0.053					0.179			0.345			0.997			0.262			0.388		0.072		0.628		0.448
组别		AST (IU/L)			HCY (μmol/L)			GGT (IU/L)			ALP (IU/L)			TC (mmol/L)			TG (mmol/L)				HLD-C (mmol/L)		LDL-C (mmol/L)
训练集		30(22,62)			12(9,17)			55(36,88)			82(66,95)			5.24(4.28,6.22)			2.27(1.53,3.91)				1.11(0.98,1.33)		3.27(2.60,3.93)
验证集		37(23,59)			11(9,16)			54(36,91)			82(65,101)			5.37(4.3,6.06)			2.64(1.79,3.40)				1.20(1.04,1.33)		3.37(2.71,4.07)
χ²/Z值		-0.543			-0.969			-0.315			-0.196			-0.357			-1.203				-1.469		-0.839
P值		0.587			0.333			0.753			0.844			0.753			0.229				0.142		0.402

组别			例数	年龄 (岁)			性别[例(%)]						BMI[例(%)]								高血压病 [例(%)]	吸烟史 [例(%)]		饮酒史 [例(%)]
组别			例数	年龄 (岁)			男性			女性			正常			超重			肥胖		高血压病 [例(%)]	吸烟史 [例(%)]		饮酒史 [例(%)]
训练集			199	53(42,61)			122.0(61.3)			77.0(38.7)			37(18.6)			67(33.7)			95(47.7)		87(43.7)	63(31.7)		28(14.1)
验证集			83	50(40,60)			43.0(51.8)			40.0(48.2)			15(18.1)			29(34.9)			39(47.7)		31(37.3)	17(20.5)		5(6.02)
χ²/Z值				-0.502			2.177						0.043								0.976	3.600		3.670
P值				0.615			0.140						0.979								0.323	0.058		0.055
组别	HOMA-IR					FPG (mmol/L)			HbA₁c (%)			UA (mmol/L)			WBC (×10⁹/L)			PLT (×10⁹/L)		PWR		ALB (g/L)		ALT (IU/L)
训练集	7.86(4.4,13.8)					9.88(7.10, 13.5)			8.1(6.7, 9.6)			367(300,453)			7.5(6.14,9.05)			231(200,275)		28.98(24.62,36.9)		45(42,47)		44(27,78)
验证集	5.83(4.27, 10.38)					8.72(6.75, 12.76)			7.8(6.4, 9.6)			350(326,435)			7.36(5.89,8.6)			236(211,282)		34.0(41.0,47.0)		45(41,47)		55(29,83)
χ²/Z值	-1.938					-1.345			-0.944			-0.004			-1.122			-0.863		-2.351		-0.438		-0.758
P值	0.053					0.179			0.345			0.997			0.262			0.388		0.072		0.628		0.448
组别		AST (IU/L)			HCY (μmol/L)			GGT (IU/L)			ALP (IU/L)			TC (mmol/L)			TG (mmol/L)				HLD-C (mmol/L)		LDL-C (mmol/L)
训练集		30(22,62)			12(9,17)			55(36,88)			82(66,95)			5.24(4.28,6.22)			2.27(1.53,3.91)				1.11(0.98,1.33)		3.27(2.60,3.93)
验证集		37(23,59)			11(9,16)			54(36,91)			82(65,101)			5.37(4.3,6.06)			2.64(1.79,3.40)				1.20(1.04,1.33)		3.37(2.71,4.07)
χ²/Z值		-0.543			-0.969			-0.315			-0.196			-0.357			-1.203				-1.469		-0.839
P值		0.587			0.333			0.753			0.844			0.753			0.229				0.142		0.402

变量	回归系数	标准误	OR值	95%CI		Z值	P值
变量	回归系数	标准误	OR值	下限	上限	Z值	P值
年龄	-0.005	0.011	0.995	0.974	1.017	-0.463	0.644
性别	0.137	0.305	1.146	0.631	2.084	0.447	0.655
高血压病	0.529	0.299	1.698	0.945	3.050	1.771	0.076
吸烟史	0.053	0.317	1.054	0.566	1.962	0.166	0.868
饮酒史	0.524	0.412	1.689	0.753	3.786	1.272	0.203
BMI	0.544	0.407	1.723	0.776	3.825	1.336	1.336
PLT	-0.010	0.003	0.990	0.984	0.996	-3.662	<0.001
WBC	0.071	0.065	1.073	0.945	1.219	1.090	0.276
PWR	-0.090	0.021	0.914	0.877	0.952	-4.385	<0.001
ALB	-0.032	0.028	0.969	0.917	1.024	-1.115	0.265
ALP	0.014	0.006	1.014	1.002	1.026	2.369	0.018
ALT	0.012	0.003	1.013	1.007	1.019	3.703	<0.001
AST	0.022	0.005	1.023	1.013	1.033	4.550	<0.001
GGT	0.009	0.003	1.009	1.003	1.015	2.867	0.004
TC	-0.099	0.097	0.906	0.749	1.095	-1.017	0.309
TG	-0.025	0.037	0.975	0.907	1.049	-0.667	0.505
HDL-C	-0.753	0.464	0.471	0.190	1.169	-1.624	0.104
LDL-C	-0.054	0.142	0.947	0.717	1.251	-0.380	0.704
UA	0.030	0.013	1.030	1.004	1.057	2.349	0.019
HbA₁c	0.056	0.075	1.057	0.913	1.225	0.739	0.460
FPG	0.045	0.037	1.046	0.973	1.125	1.235	0.217
HOMA-IR	0.020	0.017	1.020	0.987	1.055	1.144	0.253
HCY	0.113	0.030	1.119	1.056	1.187	3.811	<0.001

变量	回归系数	标准误	OR值	95%CI		Z值	P值
变量	回归系数	标准误	OR值	下限	上限	Z值	P值
年龄	-0.005	0.011	0.995	0.974	1.017	-0.463	0.644
性别	0.137	0.305	1.146	0.631	2.084	0.447	0.655
高血压病	0.529	0.299	1.698	0.945	3.050	1.771	0.076
吸烟史	0.053	0.317	1.054	0.566	1.962	0.166	0.868
饮酒史	0.524	0.412	1.689	0.753	3.786	1.272	0.203
BMI	0.544	0.407	1.723	0.776	3.825	1.336	1.336
PLT	-0.010	0.003	0.990	0.984	0.996	-3.662	<0.001
WBC	0.071	0.065	1.073	0.945	1.219	1.090	0.276
PWR	-0.090	0.021	0.914	0.877	0.952	-4.385	<0.001
ALB	-0.032	0.028	0.969	0.917	1.024	-1.115	0.265
ALP	0.014	0.006	1.014	1.002	1.026	2.369	0.018
ALT	0.012	0.003	1.013	1.007	1.019	3.703	<0.001
AST	0.022	0.005	1.023	1.013	1.033	4.550	<0.001
GGT	0.009	0.003	1.009	1.003	1.015	2.867	0.004
TC	-0.099	0.097	0.906	0.749	1.095	-1.017	0.309
TG	-0.025	0.037	0.975	0.907	1.049	-0.667	0.505
HDL-C	-0.753	0.464	0.471	0.190	1.169	-1.624	0.104
LDL-C	-0.054	0.142	0.947	0.717	1.251	-0.380	0.704
UA	0.030	0.013	1.030	1.004	1.057	2.349	0.019
HbA₁c	0.056	0.075	1.057	0.913	1.225	0.739	0.460
FPG	0.045	0.037	1.046	0.973	1.125	1.235	0.217
HOMA-IR	0.020	0.017	1.020	0.987	1.055	1.144	0.253
HCY	0.113	0.030	1.119	1.056	1.187	3.811	<0.001

变量	回归系数	标准误	OR值	95%CI		Z值	P值
变量	回归系数	标准误	OR值	下限	上限	Z值	P值
PWR	-0.082	0.025	0.921	0.877	0.967	-3.308	<0.001
AST	0.021	0.005	1.021	1.011	1.031	3.760	<0.001
UA	0.032	0.016	1.032	1.001	1.066	1.981	0.048
HCY	0.096	0.033	1.101	1.032	1.175	2.964	0.003