Computed tomography-based multi-organ radiomics nomogram model for predicting the risk of esophagogastric variceal bleeding in cirrhosis

Table 1 Clinical characteristics of the patients, n (%)

Characteristics	Training cohort (n = 145)	Validation cohort (n = 63)	P value
Age (years)	54.6 ± 11.6	54.3 ± 13.8	0.869
Sex			0.250
Male	82 (56.6)	41 (65.1)
Female	63 (43.4)	22 (34.9)
Etiology			0.112
HBV	95 (65.5)	44 (69.8)
Alcohol	18 (12.4)	1 (1.6)
PBC	9 (6.2)	4 (6.3)
AIH	5 (3.4)	1 (1.6)
HCV	2 (1.4)	2 (3.2)
HLD	2 (1.4)	1 (1.6)
Other	14 (9.7)	10 (15.9)
Ascites			0.624
Absent	66 (45.5)	31 (49.2)
Present	79 (54.5)	32 (50.8)
Hypertension			0.149
Absent	129 (89.0)	60 (95.2)
Present	16 (11.0)	3 (4.8)
PVT			0.175
Absent	118 (81.4)	46 (73)
Present	27 (18.6)	17 (27)
Child-Pugh			0.629
Class A	55 (37.9)	27 (42.9)
Class B	68 (46.9)	25 (39.7)
Class C	22 (15.2)	11 (17.5)
AFP (μg/L)			0.772
< 20	122 (84.1)	54 (85.7)
≥ 20	23 (15.9)	9 (14.3)
ALB (g/L), mean ± SD	34.5 ± 6.0	33.5 ± 6.0	0.271
PT (second), median (range)	16.1 (14.9-17.5)	15.8 (14.7-17.4)	0.480
PLT (109/L), median (range)	54.0 (41.0-73.5)	57.0 (43.0-84.0)	0.395
ALT (U/L), median (range)	28.0 (19.5-50.0)	31.0 (21.0-57.0)	0.362
AST (U/L), median (range)	42.0 (29.5-69.0)	45.0 (29.0-73.0)	0.754
GGT (U/L), median (range)	44.0 (24.0-97.5)	44.0 (24.0-97.0)	0.953
TBIL (μmol/L), median (range)	28.0 (20.4-44.1)	23.1 (18.3-43.9)	0.226
DBIL (μmol/L), median (range)	10.0 (6.9-16.4)	9.1 (6.4-16.8)	0.712
IBIL (μmol/L), median (range)	17.8 (11.7-27.3)	14.9 (10.3-22.5)	0.076

HBV: Hepatitis B virus; PBC: Primary biliary cirrhosis; AIH: Autoimmune hepatitis; HCV: Hepatitis C virus; HLD: Hepatolenticular degeneration; PVT: Portal vein thrombosis; AFP: Alpha-fetoprotein; ALB: Serum albumin; PT: Prothrombin time; PLT: Platelet count; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Glutamyl transpeptidase; TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Indirect bilirubin.

Table 2 Univariate and multivariable analysis of clinical variables

Variables	Univariate logistic regression		Multivariable logistic regression
	OR (95%CI)	P value	OR (95%CI)	P value
Age	1.000 (0.978-1.022)	0.973
Sex	1.677 (0.959-2.932)	0.070
Etiology	1.008 (0.880-1.154)	0.905
Ascites	2.826 (1.597-5.001)	< 0.001	2.625 (1.367-5.039)	0.004
Hypertension	0.690 (0.268-1.775)	0.441
PVT	4.622 (2.215-9.645)	< 0.001	3.500 (1.547-7.916)	0.003
Child-Pugh	1.352 (0.916-2.007)	0.130
AFP	0.977 (0.457-2.088)	0.953
ALB	0.965 (0.921-1.011)	0.135
PT	1.158 (1.032-1.299)	0.013	1.199 (1.033-1.390)	0.017
PLT	0.999 (0.992-1.007)	0.832
ALT	0.978 (0.966-0.991)	0.001
AST	0.982 (0.973-0.992)	0.001
GGT	0.998 (0.995-1.001)	0.136
TBIL	0.996 (0.988-1.005)	0.405
DBIL	0.994 (0.981-1.008)	0.427
IBIL	0.995 (0.977-1.012)	0.546

PVT: Portal vein thrombosis; AFP: Alpha-fetoprotein; ALB: Serum albumin; PT: Prothrombin time; PLT: Platelet count; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Glutamyl transpeptidase; TBIL: Total bilirubin; DBIL: Direct bilirubin; IBIL: Indirect bilirubin.

Table 3 Area under the receiver operating characteristic curve values of different models in training and validation cohorts

Models	Training cohort		Validation cohort
	AUC (95%CI)	P value	AUC (95%CI)	P value
Rad-score (liver)	0.801 (0.727-0.875)	< 0.001	0.763 (0.646-0.880)	0.002
Rad-score (spleen)	0.831 (0.766-0.897)	< 0.001	0.792 (0.677-0.906)	0.016
Rad-score (esophagus)	0.864 (0.807-0.922)	< 0.001	0.857 (0.762-0.952)	0.109
Rad-score (liver+ spleen + esophagus)	0.930 (0.891-0.970)	0.049	0.886 (0.808-0.964)	0.139
Clinical model	0.727 (0.644-0.811)	< 0.001	0.692 (0.556-0.828)	< 0.001
RC model	0.951 (0.919-0.983)		0.93 (0.872-0.987)

P value is the results of Delong test between each model and the RC model. AUC: Area under the receiver operating characteristic curve; RC model: Radiomics-clinical model.

Table 4 Evaluation of predictive performance in training and validation cohorts

Models	Cohort	Sensitivity	Specificity	Accuracy	PPV	NPV
Rad-score (liver)	Training	0.656	0.815	0.745	0.737	0.750
	Validation	0.643	0.686	0.667	0.621	0.706
Rad-score (spleen)	Training	0.750	0.765	0.759	0.716	0.795
	Validation	0.714	0.829	0.778	0.769	0.784
Rad-score (esophagus)	Training	0.734	0.802	0.772	0.746	0.793
	Validation	0.786	0.857	0.825	0.815	0.833
Rad-score (liver + spleen + esophagus)	Training	0.844	0.852	0.848	0.818	0.873
	Validation	0.779	0.886	0.794	0.826	0.775
Clinical model	Training	0.531	0.790	0.676	0.667	0.687
	Validation	0.571	0.686	0.635	0.600	0.667
RC model	Training	0.875	0.877	0.876	0.848	0.899
	Validation	0.821	0.857	0.841	0.821	0.857

PPV: Positive predictive value; NPV: Negative predictive value; RC model: Radiomics-clinical model.