Application of artificial intelligence model in precise risk stratification and treatment decision-making for acute variceal bleeding in cirrhosis

Table 1 Comparison of non-invasive diagnostic tools for high-risk esophageal varices in cirrhotic patients[26-28,30,31]

Model	Parameters	Detection modalities	Target etiology	Diagnostic performance (AUC)	Main limitations
FIB-4plus (XGBoost)	FIB-4 (age, AST, ALT, PLT) + LSM + SSM	Serological testing + TE	Compensated cirrhosis (predominantly HBV-related)	Training: 0.927; validation 1: 0.919; validation 2: 0.902	Etiological selection bias; lack of long-term prognostic data; relatively low interpretability of XGBoost black-box model
LSM + SSM logistic regression model	LSM, SSM	TE	Viral cirrhosis (HBV/HCV)	Derivation: 0.965; external validation: 1.000	Restricted to viral cirrhosis; small total sample size (n = 200); no long-term follow-up data
Multi-organ CT radiomics SVM model	2358 radiomic features extracted from portal venous-phase CT (liver, spleen, and esophagus 5 cm above the cardia)	Multislice spiral CT (portal venous phase enhancement)	Mixed-etiology cirrhosis	Training: 0.983; internal validation: 0.834; external validation: 0.736	Marked performance degradation in external validation; complex radiomic feature extraction; requires dedicated software and trained personnel
Meta-analysis of SSM alone	SSM	Ultrasound elastography (TE/SWE) + magnetic resonance elastography		0.83	Significant between-study heterogeneity; low positive predictive value (54%); positive results still require confirmatory endoscopy
Meta-analysis comparing CT, LSM, and MRI	Head-to-head comparison of diagnostic performance between CT, LSM, and MRI	Multislice spiral CT + TE + MRI	All cirrhosis subtypes	CT: 0.94; LSM: 0.85; MRI: 0.83	Indirect comparison between studies; moderate heterogeneity; no standardized universal diagnostic threshold provided

AUC: Area under the curve; FIB-4plus: Fibrosis-4 plus; LSM: Liver stiffness measurement; SSM: Spleen stiffness measurement; CT: Computed tomography; SVM: Support vector machine; MRI: Magnetic resonance imaging; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; PLT: Platelet count; TE: Transient elastography; SWE: Shear wave elastography; HBV: Hepatitis B virus; HCV: Hepatitis C virus.