Noninvasive model based on liver and spleen stiffness for predicting clinical decompensation in patients with cirrhosis

Table 1 Comparison of the general characteristics of the modeling group

Parameter	Patients with compensatory stage of cirrhosis, n = 72	Patients with decompensation of cirrhosis, n = 68	T value/χ2value	P value
Age, years	52.83 ± 12.2	53.16 ± 10.9	-0.168	0.867
Male (%)	40 (55.6)	40 (58.8)	0.153	0.696
Etiology, HBV/HCV	52/20	62/6	8.308	0.004

HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 2 Comparison of general characteristics in the external validation group

Parameter	Patients with compensatory stage of cirrhosis, n = 28	Patients with decompensation of cirrhosis, n = 32	T value/χ2value	P value
Age, years	52.54 ± 13.7	54.97 ± 10.4	-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

HBV: Hepatitis B virus; HCV: Hepatitis C virus.

Table 3 Univariate analysis of parameters in patients with compensated and decompensated cirrhosis

Parameter	Patients with compensatory stage of cirrhosis, n = 72	Patients with decompensation of cirrhosis, n = 68	t/Z	P value
SSM, kPa	23.50 ± 6.1	18.32 ± 4.2	5.866	< 0.001
PLT, × 109/L	110.51 ± 69.1	61.81 ± 25.7	5.463	< 0.001
LSM, kPa	15.53 ± 5.7	23.86 ± 5.2	-9.023	< 0.001
ALT, IU/L	36.00 (24.00, 47.75)	27.50 (17.00, 42.25)	-2.490	0.013
AST, IU/L	40.50 (26.75, 58.75)	38.00 (29.00, 56.75)	-0.452	0.651
ALP, IU/L	105.00 (77.50, 143.00)	98.50 (79.25, 135.50)	-0.709	0.478
GGT, IU/L	61.00 (28.00, 120.00)	34.50 (19.25, 59.50)	-3.718	< 0.001
SLD, mm	12.99 ± 3.0	15.68 ± 3.1	-5.282	< 0.001
TBIL, μmol/L	29.64 ± 27.0	31.27 ± 16.2	-0.430	0.668
ALB, g/dL	38.69 ± 6.4	34.43 ± 7.4	3.691	< 0.001
TCHO, mmol/L	3.67 ± 1.3	3.09 ± 0.9	2.939	0.004
PT, seconds	12.08 ± 1.9	13.70 ± 2.5	-4.322	< 0.001
INR	1.10 ± 0.2	1.24 ± 0.2	-4.029	< 0.001
PTA,%	84.91 ± 18.9	72.37 ± 17.0	4.123	< 0.001
PVD, mm	12.03 ± 1.6	13.78 ± 2.4	-5.072	< 0.001
CTLV, cm3	1055.93 ± 344.8	898.64 ± 257.3	3.045	0.003
CTSV, cm3	519.10 ± 296.0	842.19 ± 416.3	-5.315	< 0.001

SSM: Spleen stiffness measurement; PLT: Platelet; LSM: Liver stiffness measurement; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; GGT: Gamma-glutamyl transferase; SLD: Spleen length diameter; TBIL: Total bilirubin; ALB: Albumin; TCHO: Total cholesterol; PT: Prothrombin time; INR: International normalized 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 in patients with compensated and decompensated cirrhosis

Parameter	Patients with compensatory stage of cirrhosis, n = 72	Patients with decompensation of cirrhosis, n = 68	t/Z	P value
SSM, kPa	23.50 ± 6.1	18.32 ± 4.2	5.866	< 0.001
PLT, × 109/L	110.51 ± 69.1	61.81 ± 25.7	5.463	0.575
LSM, kPa	15.53 ± 5.7	23.86 ± 5.2	-9.023	< 0.001
ALT, IU/L	36.00 (24.00, 47.75)	27.50 (17.00, 42.25)	-2.490	0.597
GGT, IU/L	61.00 (28.00, 120.00)	34.50 (19.25, 59.50)	-3.718	0.566
SLD, mm	12.99 ± 3.0	15.68 ± 3.1	-5.282	0.037
ALB, g/dL	38.69 ± 6.4	34.43 ± 7.4	3.631	0.207
TCHO, mmol/L	3.67 ± 1.3	3.09 ± 0.9	2.939	0.224
PT, seconds	12.08 ± 1.9	13.70 ± 2.5	-4.322	0.480
INR	1.10 ± 0.2	1.24 ± 0.2	-4.029	0.584
PTA,%	84.91 ± 18.9	72.37 ± 17.0	4.123	0.623
PVD, mm	12.03 ± 1.6	13.78 ± 2.4	-5.072	0.773
CTLV, cm3	1055.93 ± 344.8	898.64 ± 257.3	3.045	0.967
CTSV, cm3	519.10 ± 296.0	842.19 ± 416.3	-5.315	0.895

SSM: Spleen stiffness measurement; PLT: Platelet; LSM: Liver stiffness measurement; ALT: Alanine aminotransferase; GGT: Gamma-glutamyl transferase; SLD: Spleen length diameter; ALB: Albumin; TCHO: Total cholesterol; PT: Prothrombin time; INR: International normalized 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 noninvasive prediction model

Parameter	B	SE	Wald	Sig	Exp (B)	95%CI of exp (B)
SSM	-0.279	0.066	17.768	< 0.001	0.756	0.664-0.861
LSM	0.348	0.067	26.728	< 0.001	1.416	1.241-1.616
SLD	0.272	0.110	6.053	0.014	1.312	1.057-1.630
Constant	-4.969	2.245	4.899	0.027	0.007

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

Table 6 Comparison of various parameters of each model

	Area	SE	Sig	95%CI of exp (B)
LSPS	0.834	0.034	< 0.001	0.767-0.901
VRI	0.824	0.035	< 0.001	0.756-0.891
AAR	0.670	0.046	0.001	0.580-0.760
Baveno VI1	0.680	0.045	< 0.001	0.591-0.769
The new model	0.944	0.018	< 0.001	0.910-0.979

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

LSPS: Liver stiffness-spleen diameter-platelet ratio; VRI: Variceal risk index; AAR: Aspartate aminotransferase-alanine aminotransferase ratio; CI: Confidence interval.

Table 7 Comparison of various parameters of each model

	Sensitivity, (%)	Specificity, (%)	Accuracy, (%)	Positive predictive value	Negative predictive value	Youden index	Cutoff value
LSPS	95.59	59.72	73.60	69.17	93.47	0.55	2.71
VRI	66.18	84.72	72.90	80.37	72.60	0.51	0.80
AAR	76.47	56.94	57.10	62.67	71.90	0.33	1.28
Baveno VI1	98.53	37.50	67.10	59.85	96.43	0.36
The new model	85.29	88.89	85.00	87.89	86.47	0.74	0.56

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

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