Non-invasive prediction model for high-risk esophageal varices in the Chinese population

doi:10.3748/wjg.v26.i21.2839

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

World J Gastroenterol. Jun 7, 2020; 26(21): 2839-2851
Published online Jun 7, 2020. doi: 10.3748/wjg.v26.i21.2839

Table 1 Comparison of general characteristics in the modeling group, n

Parameter	Patients with HEVs, n = 56	Patients with LEVs, n = 30	All patients, n = 86	P value
Age in yr	52.93 ± 11.61	54.70 ± 12.24	53.55 ± 11.79	0.35
Male (%)	33 (58.9)	14 (46.7)	47 (54.7)	0.43
Etiology, HBV/HCV	51/5	22/8	73/13	0.47
Course of disease in mo	48.3 ± 12.1	46.7 ± 11.3	48.1 ± 11.6	0.45
Child-Pugh class, A/B/C	31/19/6	9/16/0	40/35/6	< 0.05
Diameter of EVs in mm	0.8 ± 0.2	0.3 ± 0.1	0.6 ± 0.2	< 0.01
Red sign	39	0	39	< 0.01

P < 0.05 is considered statistically significant. HEVs: High-risk esophageal varices; LEVs: Low-risk esophageal varices; HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Comparison of general characteristics in the external validation group, n

Parameter	Patients with HEVs, n = 31	Patients with LEVs, n = 19	All patients, n = 50	P value
Age in yr	51.86 ± 10.93	55.33 ± 11.98	54.15 ± 10.38	0.37
Male (%)	18 (58.1)	10 (62.6)	28 (56.0)	0.46
Etiology, HBV/HCV	21/10	16/3	37/13	0.51
Course of disease in mo	47.6 ± 11.3	45.8 ± 12.1	46.9 ± 10.9	0.43
Child-Pugh class, A/B/C	11/18/2	7/12/0	18/30/2	< 0.05
Diameter of EVs in mm	0.8 ± 0.1	0.4 ± 0.1	0.6 ± 0.2	< 0.01
Red sign	11	0	11	< 0.01

P < 0.05 is considered statistically significant. HEVs: High-risk esophageal varices; LEVs: Low-risk esophageal varices; HBV: Hepatitis B virus; HCV; Hepatitis C virus.

Table 3 Univariate analysis of parameters of patients with high-risk esophageal varices and low-risk esophageal varices

Parameter	Patients with HEVs, n = 56	Patients with LEVs, n = 30	P value
PVSA, mm³	227.04 ± 76.66	183.81 ± 69.10	< 0.01
PVD, mm	14.35 ± 2.64	12.67 ± 2.58	< 0.01
SVD, mm	10.08 ± 3.36	8.52 ± 2.67	0.02
CTLV, cm³	901.95 ± 219.00	935.18 ± 299.83	0.66
CTSV, cm³	917.30 ± 394.37	546.00 ± 375.35	< 0.01
Ratio of liver and spleen volume	1.18 ± 0.57	3.16 ± 5.25	< 0.01
SSV, cm³	177.03 ± 33.41	175.34 ± 29.76	0.81
SLV, cm³	1052.08 ± 151.88	1044.40 ± 135.25	0.80
Rate of change of liver volume, %	-0.14 ± 0.20	-0.10 ± 0.29	0.68
Rate of change of spleen volume, %	4.21 ± 2.11	2.06 ± 2.07	< 0.01
Change of liver volume, cm³	-150.13 ± 224.10	-109.22 ± 300.13	0.56
Change of spleen volume, cm³	740.27 ± 382.77	370.66 ± 365.27	< 0.01
Spleen diameter, cm	15.81 ± 2.67	12.67 ± 2.58	<0.01
ALT, IU/L	57.68 (15-176)	40.97 (13-88)	<0.01
AST, IU/L	36.38 (10-81)	61.26 (18-164)	<0.01
TBIL, μmol/L	27.89 (3.5-73.69)	34.12 (6-119.7)	0.59
PT in s	13.69 (9.9-24)	13.50 (9.1-18.2)	0.85
TT in s	20.44 (17.2-27.9)	20.28 (16.9-23.1)	0.01
PLT, × 10⁹/L	57.68 (15-176)	73.77 (29-159)	0.05
LSM, kPa	20.45 (9.4-36.1)	26.8 (7.6-75)	0.26

P < 0.05 is considered statistically significant. HEVs: High-risk esophageal varices; LEVs: Low-risk esophageal varices; PVSA: Portal vein surface area; PVD: Portal vein diameter; SVD: Splenic vein diameter; CTLV: Actual liver volume measured by CT; CTSV: Actual spleen volume measured by CT; SSV: Standard spleen volume calculated by equation; SLV: Standard liver volume calculated by equation; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TBIL: Total bilirubin; PT: Prothrombin time; TT: Thrombin time; LSM: Liver stiff measurement.

Table 4 Multivariate analysis of parameters of patients with high-risk esophageal varices and low-risk esophageal varices

Parameter	Patients with HEVs, n = 56	Patients with LEVs, n = 30	P value
PVSA, mm³	227.04 ± 76.66	183.81 ± 69.10	0.52
PVD, mm	14.35 ± 2.64	12.67 ± 2.58	0.60
SVD, mm	10.08 ± 3.36	8.52 ± 2.67	0.20
CTSV, cm³	917.30 ± 394.37	546.00 ± 375.35	0.26
Ratio of liver and spleen volume, %	1.18 ± 0.57	3.16 ± 5.25	< 0.01
Rate of change of spleen volume, %	4.21 ± 2.11	2.06 ± 2.07	0.047
Change of spleen volume, cm³	740.27 ± 382.77	370.66 ± 365.27	0.30
Spleen diameter, cm	15.81 ± 2.67	12.67 ± 2.58	0.58
ALT, IU/L	57.68 (15-176)	40.97 (13-88)	0.71
AST, IU/L	36.38 (10-81)	61.26 (18-164)	< 0.01
TT in s	20.44 (17.2-27.9)	20.28 (16.9-23.1)	0.93

P < 0.05 is considered statistically significant. HEVs: High-risk esophageal varices; LEVs: Low-risk esophageal varices; PVSA: Portal vein surface area; PVD: Portal vein diameter; SVD: Splenic vein diameter; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; PT: Prothrombin time; TT: Thrombin time.

Table 5 Parameters used to establish the non-invasive prediction model

Parameter	B	SE	Wals	df	Sig	Exp (B)	95%CI of exp (B)
Ratio of liver and spleen volume	-2.162	0.683	10.028	1	0.002	0.115	0.030-0.439
Rate of spleen volume change	-0.314	0.246	1.619	1	0.203	0.731	0.451-1.185
AST	-0.070	0.020	12.672	1	0.000	0.933	0.898-0.969
Constant	8.342	2.413	11.946	1	0.001	4194.879

AST: Aspartate aminotransferase; df: Degree of freedom; CI: Confidence interval.

Table 6 Comparison of various parameters of each model

	Area	SE	Sig	95%CI of exp (B)	Sensitivity	Specificity	Youden’s index
The new model	0.865	0.054	0.000	0.759-0.970	0.91	0.80	0.71
LSPS	0.591	0.072	0.210	0.450-0.732	0.85	0.37	0.22
VRI	0.717	0.065	0.003	0.589-0.844	0.70	0.74	0.44
APRI	0.431	0.074	0.344	0.285-0.577	0.95	0.15	0.10
AAR	0.445	0.080	0.447	0.288-0.601	0.93	0.33	0.26

CI: Confidence interval.

Table 7 Comparison of accuracy of each model in predicting high-risk esophageal varices of patients in the modeling group

	Accuracy, %	Positive predictive value, %	Negative predictive value, %	Cutoff value
New model	84.9	96.4	63.3	0.5713638
LSPS	82.1	85.0	37.0	3.0852585
VRI	70.1	70.0	74.1	0.52695
APRI	67.4	96.4	13.3	0.5671263
AAR	68.6	89.3	30	0.9861111

LSPS: Liver stiffness-spleen diameter to platelet ratio score; VRI: Variceal risk index; APRI: Aspartate transaminase to platelet ratio index; AAR: Aspartate transaminase/alanine aminotransferase ratio.

Citation: Yang LB, Xu JY, Tantai XX, Li H, Xiao CL, Yang CF, Zhang H, Dong L, Zhao G. Non-invasive prediction model for high-risk esophageal varices in the Chinese population. World J Gastroenterol 2020; 26(21): 2839-2851
URL: https://www.wjgnet.com/1007-9327/full/v26/i21/2839.htm
DOI: https://dx.doi.org/10.3748/wjg.v26.i21.2839