A Nomogram to Predict Day-7 Total Bilirubin in Hepatitis B Virus-Related Cirrhosis: An Early Treatment-Response Assessment Tool.

Authors

Yinghao Yang, Changning He, Yang Yang, Yuanyuan Zhao, Xiaofeng Dong, Dong Liang

Published in

Infection and drug resistance. Volume 19. Pages 611768. Epub Jun 30, 2026.

Abstract

To develop and validate a nomogram using routine admission indicators to predict total bilirubin on day 7 (TBil-Day7) in hepatitis B virus-related liver cirrhosis (HBV-LC) patients, enabling early identification of inadequate short-term TBil response and providing a reference for intensive treatment.
We retrospectively enrolled 284 HBV-LC patients, randomly assigned 7:3 to training (n=198) and internal validation (n=86) cohorts. Candidate variables were clinical and laboratory parameters available within 24 hours of admission, with TBil-Day7 as the outcome. Predictors were selected via least absolute shrinkage and selection operator (LASSO) regression, and a multiple linear regression model was built and visualized as a nomogram. Model performance was evaluated using the coefficient of determination (R²), root mean square error (RMSE), mean absolute error (MAE), and the proportion of predicted values falling within ±20 μmol/L of the observed TBil-Day7 values.
LASSO regression identified four predictors: admission TBil, direct bilirubin (DBil), aspartate aminotransferase (AST), and international normalized ratio (INR). The prediction equation was: TBil-Day7 (μmol/L) = -23.0159 + 0.5721×TBil + 0.5847×DBil + 0.0601×AST + 14.0707×INR. The training cohort had an R² of 0.932. In the internal validation cohort, R²=0.75, RMSE=38.06 μmol/L, MAE=21.27 μmol/L, and 74.4% of predictions were within ±20 μmol/L of actual values. The calibration curve showed good agreement between predicted and observed TBil-Day7.
This nomogram, incorporating four routine admission indicators (TBil, DBil, AST, INR), can predict TBil-Day7 in HBV-LC patients with reasonable accuracy. It facilitates early identification of high-risk patients with insufficient TBil decline and allows estimation of short-term treatment response at admission.

PMID:
42405312
Bibliographic data and abstract were imported from PubMed on 06 Jul 2026.

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