Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

Table 1 Comparison of general characteristics in the modelling group

Parameter	Patients with LEVs, n = 74	Patients with HEVs, n = 66	T value/χ2 value	P value
Age in yr	50.88 ± 11.60	55.36 ± 11.10	-2.333	0.021
Male (%)	43 (58.1%)	37 (56.1%)	0.060	0.807
Etiology, HBV/HCV	61/13	53/13	0.105	0.746

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

Parameter	Patients with LEVs, n = 28	Patients with HEVs, n = 32	T value/χ2 value	P value
Age in yr	52.54 ± 13.70	54.97 ± 10.40	-0.780	0.438
Male (%)	15 (53.6%)	14 (43.8%)	0.577	0.448
Etiology, HBV/HCV	25/3	30/2	0.024	0.876

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 LEVs, n = 74	Patients with HEVs, n = 66	t/Z	P value
SSM, KPa	22.70 ± 6.00	19.06 ± 4.90	3.880	< 0.001
PLT, × 109/L	108.55 ± 68.10	62.53 ± 29.00	5.096	< 0.001
LSM, KPa	14.90 ± 5.10	24.83 ± 4.30	-12.354	< 0.001
ALT, IU/L	37.50 (26.00, 49.50)	23.00 (16.00, 35.00)	-4.278	< 0.001
AST, IU/L	43.00 (31.75, 69.00)	34.50 (27.75, 45.25)	-2.796	0.005
ALP, IU/L	108.00 (81.25, 137.25)	93.50 (78.00, 128.75)	-1.012	0.311
GGT, IU/L	60.50 (28.00, 114.00)	33.00 (19.75, 58.75)	-3.609	< 0.001
SLD, mm	13.58 ± 3.10	15.10 ± 3.30	-2.806	0.006
TBIL, μmol/L	22.63 (16.01, 34.96)	27.80 (18.05, 39.65)	-0.960	0.337
ALB, g/dL	37.16 ± 8.30	36.02 ± 5.80	0.935	0.351
TCHO, mmol/L	3.57 ± 1.40	3.18 ± 0.90	1.981	0.050
PT, s	12.45 ± 2.20	13.34 ± 2.50	-2.284	0.024
INR	1.13 ± 0.20	1.21 ± 0.20	-2.175	0.031
PTA, %	82.15 ± 20.80	75.09 ± 16.10	2.228	0.028
PVD, mm	12.20 ± 1.90	13.64 ± 2.30	-4.024	< 0.001
CTLV, cm3	1031.88 ± 361.20	920.85 ± 241.50	2.111	0.037
CTSV, cm3	558.11 ± 338.70	808.25 ± 409.90	-3.951	< 0.001

P < 0.05 is considered statistically significant. HEVs: High-risk esophageal varices; LEVs: Low-risk esophageal varices; SSM: Spleen stiffness measurement; LSM: Liver stiffness measurement; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Glutamine transferase; SLD: Spleen long diameter; TBIL: Total bilirubin; ALB: Albumin; TCHO: Total cholesterol; PT: Prothrombin time; INR: International prothrombin ratio; PTA: Prothrombin activity; PVD: Portal vein diameter; CTLV: Actual liver volume measured by computed tomography; CTSV: Actual spleen volume measured by computed tomography.

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

Parameter	Patients with LEVs, n = 74	Patients with HEVs, n = 66	t/Z	P value
SSM, KPa	22.70 ± 6.00	19.06 ± 4.90	3.880	0.009
PLT, × 109/L	108.55 ± 68.10	62.53 ± 29.00	5.096	0.606
LSM, KPa	14.90 ± 5.10	24.83 ± 4.30	-12.354	< 0.001
ALT, IU/L	37.50 (26.00, 49.50)	23.00 (16.00, 35.00)	-4.278	0.669
AST, IU/L	43.00 (31.75, 69.00)	34.50 (27.75, 45.25)	-2.796	0.125
	60.50 (28.00, 114.00)	33.00 (19.75, 58.75)	-3.609	0.790
SLD, mm	13.58 ± 3.10	15.10 ± 3.30	-2.806	0.952
PT, s	12.45 ± 2.20	13.34 ± 2.50	-2.284	0.883
INR	1.13 ± 0.20	1.21 ± 0.20	-2.175	0.777
PTA, %	82.15 ± 20.80	75.09 ± 16.10	2.228	0.920
PVD, mm	12.20 ± 1.90	13.64 ± 2.30	-4.024	0.220
CTLV, cm3	1031.88 ± 361.10	920.85 ± 241.50	2.111	0.892
CTSV, cm3	558.11 ± 338.70	808.25 ± 409.90	-3.951	0.713

P < 0.05 is considered statistically significant. HEVs: High-risk esophageal varices; LEVs: Low-risk esophageal varices; SSM: Spleen stiffness measurement; LSM: Liver stiffness measurement; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; SLD: Spleen long diameter; PT: Prothrombin time; INR: International prothrombin ratio; PTA: Prothrombin activity; PVD: Portal vein diameter; CTLV: Actual liver volume measured by computed tomography; CTSV: Actual spleen volume measured by computed tomography.

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

Parameter	B	S.E.	Wald	P	Exp (B)	95%CI of exp (B)
SSM	-0.228	0.074	9.647	0.002	0.796	0.689-0.919
LSM	0.642	0.123	27.245	< 0.001	1.900	1.493-2.418
Constant	-8.184	2.300	12.659	< 0.001	0.000	-

SSM: Spleen stiffness measurement; LSM: Liver stiffness measurement; CI: Confidence interval.

Table 6 Comparison of various parameters of each model

	Area	SE	P	95%CI of exp (B)
LSPS	0.835	0.033	< 0.001	0.771-0.900
VRI	0.744	0.041	< 0.001	0.663-0.824
AAR	0.641	0.046	0.004	0.550-0.732
Baveno VI	0.675	0.045	< 0.001	0.586-0.764
The new model	0.965	0.015	< 0.001	0.936-0.995

LSPS: Liver stiffness-spleen diameter to platelet ratio score; VRI: Variceal risk index; AAR: Aspartate aminotransferase/alanine aminotransferase ratio; BavenoVI: Baveno VI criteria were defined as liver stiffness measurement < 20 kPa and platelet count > 150 × 10⁹ /L; CI: Confidence interval.

Table 7 Comparison of various parameters of each model

	Sensitivity	Specificity	Accuracy, %	Positive predictive value, %	Negative predictive value, %	Cutoff value
LSPS	89.39	62.16	74.30	67.78	86.81	3.12
VRI	74.24	67.57	69.30	67.09	74.66	0.03
AAR	75.76	52.70	57.90	58.78	70.95	1.27
Baveno VI1	98.48	36.49	65.70	57.99	96.42	-
The new model	100.00	82.43	89.30	83.52	100.00	0.27

¹Baveno VI criteria were defined as liver stiffness measurement < 20 kPa and platelet count > 150 × 10⁹ /L.

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