Development of a risk prediction model for non-recovery of liver function following 3 years of chronic drug-induced liver injury

Abstract

Abstract: Objective To investigate the factors associated with the failure of liver function recovery following 3 years of chronic drug-induced liver injury (DILI) and to develop a predictive risk nomogram model.Methods Clinical data from 127 patients diagnosed with chronic DILI at the First People's Hospital of Mengcheng County between January 2017 and December 2019 were retrospectively analyzed. Patients were categorized into recovery and non-recovery groups based on their liver function status after 3 years. A comparative analysis was conducted between these groups. The study focused on multivariate analysis of factors influencing non-recovery in liver function among chronic DILI patients after 3 years. The primary Objective was to develop and validate an effective risk prediction model for chronic DILI patients whose liver function did not recover after 3 years.Results In the analysis of chronic DILI patients, no significant differences were observed between the non-recovery and recovery groups in terms of sex distribution, age, BMI, smoking and drinking history, comorbidities, medication history, clinical classification, DILI severity, inflammation grade, hemoglobin(Hb), prealbumin(PAB), white blood cell count(WBC), total bilirubin(TBIL), IgA, IgG and IgM levels(P>0.05). However, higher levels of fibrosis grade S3/S4, ALT, AST, ALP, and GGT were noted in the non-recovery group compared to the recovery group (P<0.05), along with lower platelet counts(PLT)(P<0.05). Multivariate analysis identified fibrosis grade S3/S4 (OR=2.757, 95% CI: 1.054~6.963), PLT (OR=0.347, 95% CI: 0.143~0.844), ALT (OR=3.228, 95% CI: 1.328~7.846) and AST (OR=3.031, 95% CI: 1.247~7.367) as independent factors influencing non-recovery of liver function in chronic DILI patients after 3 years (P<0.05). A nomoram prediction model was established using these risk factors.. The model`s validation indicated a C-index of 0.916 (95% CI: 0.872~0.935), with the correction curve closely aligning with the ideal curve (P>0.05). ROC analysis of the nomograph model revealed its efficacy in predicting the non-recovery of liver function in chronic DILI patients over a three-year period, with a sensitivity of 80.65% (95% CI: 61.94%~91.88%), specificity of 92.71% (95% CI: 85.06%~96.77%), and an AUC of 0.882 (95% CI: 0.812~0.932).Conclusion PLT, ALT and AST are all significantly asoociated with the failure of liver function recovery in patients with chronic DILI after 3 years. The nomogram model, developed based on these risk factors, demonstrates a strong predictive capability for assessing liver function recovery failure in chronic DILI patients over the same period .

Key words: Chronic, Drug induced liver injury, Liver function recovery, Risk factors, Nomogram, Prediction model

YANG Hong, XIE Peng-fei, JIANG Man. Development of a risk prediction model for non-recovery of liver function following 3 years of chronic drug-induced liver injury[J]. Chinese Hepatolgy, 2023, 28(12): 1480-1483.

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