Multimodal Ultrasound Model Based on the Left Gastric Vein in B-Viral Cirrhosis: Noninvasive Prediction of Esophageal Varices

Abstract

OBJECTIVES: To establish and verify a simple noninvasive model based on the left gastric vein (LGV) to predict the grade of esophageal varices (EV) and high-risk EV (HEV), to facilitate clinical follow-up and timely treatment. METHODS: We enrolled 320 patients with B-viral cirrhosis. All patients underwent endoscopy, laboratory tests, liver and spleen stiffness (SS), and ultrasonography. HEV were analyzed using the χ 2 test/ t test and logistic regression in the univariate and multivariate analyses, respectively. EV grades were analyzed using the variance/rank-sum test and logistic regression. A prediction model was derived from the multivariate predictors. RESULTS: In the training set, multivariate analysis showed that the independent factors of different EV grades were SS, LGV diameter, and platelet count (PLT). We developed the LGV diameter-SS to PLT ratio index (LSPI) and LGV diameter/PLT models without SS. The area under the receiver operating characteristic curve of the LSPI for diagnosis of small EV, medium EV, large EV, and HEV was 0.897, 0.899, 0.853, and 0.954, respectively, and that of the LGV/PLT was 0.882, 0.890, 0.837, and 0.942, respectively. For the diagnosis of HEV, the negative predictive value was 94.07% when LSPI < 19.8 and the positive predictive value was 91.49% when LSPI > 23.0. The negative predictive value was 95.92% when LGV/PLT < 5.15, and the positive predictive value was 86.27% when LGV/PLT > 7.40. The predicted values showed similar accuracy in the validation set. DISCUSSION: Under appropriate conditions, the LSPI was an accurate method to detect the grade of EV and HEV. Alternatively, the LGV/PLT may also be useful in diagnosing the varices when condition limited.

Small varices in chronic liver diseases

“…Xu X et al reported that the AUROC of LSPI for diagnosis of small EVs was 0.897 in the training set, whereas the AUROC increased to 0.999 in the validation set [94 ▪ ].…”

Prediction of Esophageal Varices by Non-Invasive Markers in Patients of Hepatic Cirrhosis due To Chronic Hepatitis C

“…These parameters include presence of ascites, platelet count, prothrombin time, splenic diameter, portal vein diameter, platelet count to spleen diameter ratio, serum albumin and serum bilirubin. 8 Several studies have observed that these non-invasive parameters are strong predictors of esophageal varices. 8,9,10 Several studies have also been done in Pakistan that have used these non-invasive parameters but most of them have analysed each parameter separately and only a few have used various combined scores to predict esophageal varices.…”

“…8 Several studies have observed that these non-invasive parameters are strong predictors of esophageal varices. 8,9,10 Several studies have also been done in Pakistan that have used these non-invasive parameters but most of them have analysed each parameter separately and only a few have used various combined scores to predict esophageal varices. 11,12,13 In a developing country like Pakistan endoscopy facilities are limited, expensive, and the endoscopic workload is high.…”

Validation and comparison of non-invasive prediction models based on liver stiffness measurement to identify patients who could avoid gastroscopy

“…Several NITs have been developed to rule out VNT, including platelet/MELD strategy 7 , the platelet-albumin criteria 8 , the LGV diameter-SS to PLT ratio index (LSPI) 9 , Platelet count/spleen diameter ratio (PSR) 10 , liver stiffness measurement (LSM) 11 , 12 , spleen stiffness measurement (SSM) 13 , 14 , the Baveno VI criteria (B6C) 15 , the expanded Baveno VI criteria (EB6C) 16 , LSM-spleen diameter (SD) to platelet ratio score (LSPS) 17 , and the VariScreen algorithm 18 , etc. Transient elastography (TE) has been proven to be an accurate and noninvasive technique for assessing hepatic fibrosis and liver cirrhosis 19 .…”