Development of a retinal vascular nomogram for predicting hepatitis B virus-related cirrhosis: insights into extrahepatic microcirculatory dysfunctions

Background: The progression of hepatitis B virus-related cirrhosis (HBC) is characterized by notable intrahepatic and extrahepatic microvascular alterations and dysfunctions. The retinal vasculature offers a noninvasive window to assess systemic microcirculation. This cross-sectional study aimed to evaluate retinal microcirculatory alterations in HBC and develop a retinal vascular nomogram for diagnosing HBC. Methods We included 328 participants from two medical centers between March 2019 and October 2022. Multivariate logistic regression identified independent retinal predictors of HBC, and a nomogram was constructed. Associations between retinal parameters and clinical indicators of HBC were examined using univariate analyses. Results Retinal vascular caliber, retinal vascular branching angle, and retinal vascular fractal dimension were independent predictors of HBC. The nomogram achieved an area under the receiver operating characteristic curve of 0.778, with a sensitivity of 77.5% and specificity of 65.5%. The model demonstrated good calibration (Hosmer–Lemeshow test, P = 0.376) and significant net benefit on decision curve analysis. Internal validation confirmed its reliability. Retinal vascular alterations correlated with indicators of portal hypertension and liver insufficiency. Conclusion We developed a nomogram based on retinal vascular parameters to predict HBC, providing clinicians an intuitive, noninvasive diagnostic tool. The retinal microvascular alterations in HBC may reflect extrahepatic microcirculatory dysfunctions related to portal hypertension and liver insufficiency.