Development and Validation of a Novel Nomogram to Screen for Liver Fibrosis in Individuals with Hepatitis B Core Antibody Seropositivity

Abstract Background and aim: Seropositive hepatitis B core antibody (HBcAb) could indicate hepatitis B virus infection. Individuals with positive HBcAb were reported to be more susceptible to liver disease than the general population. We aimed to create a new nomogram to screen for liver fibrosis in these individuals. Materials and Methods: Individuals with seropositive HBcAb from the National Health and Nutrition Examination Survey (NHANES) were enrolled in this study and randomly assigned to training and validation cohorts. The nomogram was established based on the results of univariate analysis, least absolute shrinkage and selection operator (LASSO) regression, and multivariate analysis. The nomogram was further assessed by area under the receiver operator characteristic curve (AUC), net reclassification index (NRI), integrated discrimination improvement (IDI), calibration curve, and decision curve analysis (DCA) curve. We also compared our nomogram with three existing models concerning liver fibrosis. Results: Our study enrolled 605 participants and collected 39 variables from NHANES data. Our nomogram was developed based on seven optimal predictors, including age, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glut amyl trans peptidase (GGT), albumin, body mass index (BMI), and hip circumference (HC). The AUC of the nomogram for liver fibrosis was 0.829 and 0.782 in training and validation cohorts, respectively. The evaluation of NRI, IDI, calibration curve, and DCA curve indicated the better performance of our nomogram compared with existing models. Conclusion: The newly constructed nomograms could serve as a promising screening tool for identifying liver fibrosis in individuals with HBcAb seropositivity.