Diagnostic accuracy of blood-based non-invasive tests for prediction of varices in pediatric portal-hypertension: A systematic review and meta-analysis

Figure 1 PRISMA flow diagram depicting study identification and selection process.

Figure 2 Methodological quality assessment of included studies according to Quality Assessment of Diagnostic Accuracy Studies-2 tool. A: Aminotransferase-to-platelet ratio index; B: Platelet count.

Figure 3 Summary diagnostic accuracy of aminotransferase-to-platelet ratio index for variceal prediction. A: Forest plot for sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) plot for prediction of esophageal/gastric varices; B: Forest plot for sensitivity, specificity, and HSROC plot for prediction of clinically significant varices. In the HSROC plot, each study is identified with a small black circle. Square denotes the combined sensitivity and specificity, grey shaded area is the 95% confidence region, and the dashed line is the 95% prediction region. EV: Esophageal/gastric varices; CSV: Clinically significant varices.

Figure 4 Summary diagnostic accuracy of platelet counts for variceal prediction. A: Forest plot for sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) plot for prediction of esophageal/gastric varices; B: Forest plot for sensitivity, specificity, and HSROC plot for prediction of clinically significant varices. In the HSROC plot, each study is identified with a small black circle. Square denotes the combined sensitivity and specificity, grey shaded area is the 95% confidence region, and the dashed line is the 95% prediction region. EV: Esophageal/gastric varices; CSV: Clinically significant varices.

Figure 5 Summary diagnostic accuracy of non-invasive indices for clinically significant varices prediction. A: Forest plot for sensitivity, specificity, and hierarchical summary receiver operating characteristic (HSROC) plot of clinical prediction rule; B: Forest plot for sensitivity, specificity, and HSROC plot of varices prediction rule; C: Forest plot for sensitivity, specificity, and HSROC plot of King’s variceal prediction score. In the HSROC plot, each study is identified with a small black circle. Square denotes the combined sensitivity and specificity, grey shaded area is the 95% confidence region, and the dashed line is the 95% prediction region.