Non-Invasive Prediction Models for Esophageal Varices and Red Signs in Patients With Hepatitis B Virus-Related Liver Cirrhosis

Liang, Huixin; Si, Hang; Liu, Mingzhu; Yuan, Lei; Ma, Xiaoqiang; Zhang, Genglin; Yang, Jinfu; Mo, Zhishuo; Zhao, Qiyi

doi:10.3389/fmolb.2022.930762

Cited by 4 publications

(2 citation statements)

References 45 publications

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“…Since a single parameter, either radiological or laboratory, is insufficient to predict EVB, combinations of different modalities were studied. Liang et al [ 18 ] proposed a statistical model named SSL-RS, which consists of the spleen diameter, splenic vein diameter, and lymphocyte ratio, to predict the red sign. The authors showed that the sensitivity and specificity could be greater than 70%.…”

Section: Modalities For Evaluating Evb Riskmentioning

confidence: 99%

Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency

Zhang,

2024

World J Gastrointest Endosc

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In this editorial, we comment on the minireview by Martino A, published in the recent issue of World Journal of Gastrointestinal Endoscopy 2023; 15 (12): 681-689. We focused mainly on the possibility of replacing the hepatic venous pressure gradient (HVPG) and endoscopy with noninvasive methods for predicting esophageal variceal bleeding. The risk factors for bleeding were the size of the varices, the red sign and the Child-Pugh score. The intrinsic core factor that drove these changes was the HVPG. Therefore, the present studies investigating noninvasive methods, including computed tomography, magnetic resonance imaging, elastography, and laboratory tests, are working on correlating imaging or serum marker data with intravenous pressure and clinical outcomes, such as bleeding. A single parameter is usually not enough to construct an efficient model. Therefore, multiple factors were used in most of the studies to construct predictive models. Encouraging results have been obtained, in which bleeding prediction was partly reached. However, these methods are not satisfactory enough to replace invasive methods, due to the many drawbacks of different studies. There is still plenty of room for future improvement. Prediction of the precise timing of bleeding using various models, and extracting the texture of variceal walls using high-definition imaging modalities to predict the red sign are interesting directions to lay investment on.

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Section: Modalities For Evaluating Evb Riskmentioning

confidence: 99%

Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency

Zhang,

2024

World J Gastrointest Endosc

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“…Rupture of esophageal varices (EVs) is a common and life-threatening complication in patients with liver cirrhosis. The incidence of EVs bleeding is approximately 5%-15% per year, the re-bleeding rate within 6 wk after EVs rupture bleeding is 30% to 40%, and the mortality rate is 15%-25%[ 3 - 5 ]. The severity of liver cirrhosis, the size of EVs and the presence or absence of the red sign (RS) are related indicators of EVs bleeding[ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

Yang¹,

Gao²,

Li³

et al. 2023

World J Gastroenterol

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BACKGROUND Acute bleeding due to esophageal varices (EVs) is a life-threatening complication in patients with cirrhosis. The diagnosis of EVs is mainly through upper gastrointestinal endoscopy, but the discomfort, contraindications and complications of gastrointestinal endoscopic screening reduce patient compliance. According to the bleeding risk of EVs, the Baveno VI consensus divides varices into high bleeding risk EVs (HEVs) and low bleeding risk EVs (LEVs). We sought to identify a non-invasive prediction model based on spleen stiffness measurement (SSM) and liver stiffness measurement (LSM) as an alternative to EVs screening. AIM To develop a safe, simple and non-invasive model to predict HEVs in patients with viral cirrhosis and identify patients who can be exempted from upper gastrointestinal endoscopy. METHODS Data from 200 patients with viral cirrhosis were included in this study, with 140 patients as the modelling group and 60 patients as the external validation group, and the EVs types of patients were determined by upper gastrointestinal endoscopy and the Baveno VI consensus. Those patients were divided into the HEVs group (66 patients) and the LEVs group (74 patients). The effect of each parameter on HEVs was analyzed by univariate and multivariate analyses, and a non-invasive prediction model was established. Finally, the discrimination ability, calibration ability and clinical efficacy of the new model were verified in the modelling group and the external validation group. RESULTS Univariate and multivariate analyses showed that SSM and LSM were associated with the occurrence of HEVs in patients with viral cirrhosis. On this basis, logistic regression analysis was used to construct a prediction model: Ln [P/(1-P)] = -8.184 -0.228 × SSM + 0.642 × LSM. The area under the curve of the new model was 0.965. When the cut-off value was 0.27, the sensitivity, specificity, positive predictive value and negative predictive value of the model for predicting HEVs were 100.00%, 82.43%, 83.52%, and 100%, respectively. Compared with the four prediction models of liver stiffness-spleen diameter to platelet ratio score, variceal risk index, aspartate aminotransferase to alanine aminotransferase ratio, and Baveno VI, the established model can better predict HEVs in patients with viral cirrhosis. CONCLUSION Based on the SSM and LSM measured by transient elastography, we established a non-invasive prediction model for HEVs. The new model is reliable in predicting HEVs and can be used as an alternative to routine upper gastrointestinal endoscopy screening, which is helpful for clinical decision making.

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Prediction of esophageal varices in patients with hepatitis B-associated liver cirrhosis by non-invasive markers

Gao¹,

Zhang²,

Gao³

et al. 2023

Gastroenterology & Endoscopy

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Non-Invasive Prediction Models for Esophageal Varices and Red Signs in Patients With Hepatitis B Virus-Related Liver Cirrhosis

Cited by 4 publications

References 45 publications

Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency

Future directions of noninvasive prediction of esophageal variceal bleeding: No worry about the present computed tomography inefficiency

Non-invasive model for predicting high-risk esophageal varices based on liver and spleen stiffness

Prediction of esophageal varices in patients with hepatitis B-associated liver cirrhosis by non-invasive markers

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