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Development and external validation of a pre-treatment nomogram for predicting drug-induced liver injury risk in tuberculosis patients
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Development and external validation of a pre-treatment nomogram for predicting drug-induced liver injury risk in tuberculosis patients
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Development and external validation of a pre-treatment nomogram for predicting drug-induced liver injury risk in tuberculosis patients
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Journal Article
Development and external validation of a pre-treatment nomogram for predicting drug-induced liver injury risk in tuberculosis patients
2025
Overview
Drug-induced liver injury (DILI) frequently complicates anti-tuberculosis (TB) treatment, particularly in regions with a high TB burden. Early pre-treatment identification of patients at elevated risk is essential for timely intervention and safer treatment outcomes. In this retrospective two-center cohort study, we collected baseline data from 2022 to 2024 of 2624 patients admitted to two tertiary hospitals before starting standard drug-susceptible anti-TB therapy (isoniazid, rifampicin, pyrazinamide, ethambutol). Patients were randomly divided into training (
n
= 1512), internal validation (
n
= 648), and external validation (
n
= 564) cohorts. Multivariable logistic regression found DILI predictors, and a pre—treatment risk—forecasting nomogram was built. Model performance was assessed by AUC, calibration plots, and decision curve analysis (DCA). Six baseline predictors emerged: age ≥ 60 years, BMI < 18.5 kg/m
2
, alcohol use, extrapulmonary TB, albumin < 35 g/L, and hemoglobin < 110 g/L. The nomogram demonstrated robust discrimination (AUCs: 0.80 training, 0.75 internal validation, 0.77 external validation) and favorable calibration and net clinical benefit on DCA. We developed and externally validated a pre-treatment nomogram for DILI risk in TB patients. By enabling risk stratification before therapy begins, this tool supports personalized monitoring and may enhance treatment safety.
Publisher
Nature Publishing Group UK,Nature Publishing Group,Nature Portfolio
Subject
/ 692/4020
/ 692/499
/ 692/699
/ 692/700
/ Adult
/ Aged
/ Antitubercular Agents - adverse effects
/ Antitubercular Agents - therapeutic use
/ Chemical and Drug Induced Liver Injury - diagnosis
/ Chemical and Drug Induced Liver Injury - epidemiology
/ Chemical and Drug Induced Liver Injury - etiology
/ Ethics
/ Female
/ Humanities and Social Sciences
/ Humans
/ Liver
/ Male
/ Nomogram
/ Patients
/ Pre-treatment risk prediction
/ Rifampin
/ Science
/ Training
