Clinical and Molecular Hepatology (Jul 2025)
Fibrosis-4plus score: a novel machine learning-based tool for screening high-risk varices in compensated cirrhosis (CHESS2004): an international multicenter study
- Bingtian Dong,
- Ruiling He,
- Shenghong Ju,
- Yuping Chen,
- Ivica Grgurevic,
- Jianzhong Ma,
- Ying Guo,
- Huizhen Fan,
- Qiang Yan,
- Chuan Liu,
- Huixiong Xu,
- Anita Madir,
- Kristian Podrug,
- Jia Wang,
- Linxue Qian,
- Zhengzi Geng,
- Shanghao Liu,
- Tao Ren,
- Guo Zhang,
- Kun Wang,
- Meiqin Su,
- Fei Chen,
- Sumei Ma,
- Liting Zhang,
- Zhaowei Tong,
- Yonghe Zhou,
- Xin Li,
- Fanbin He,
- Hui Huan,
- Wenjuan Wang,
- Yunxiao Liang,
- Juan Tang,
- Fang Ai,
- Tingyu Wang,
- Liyun Zheng,
- Zhongwei Zhao,
- Jiansong Ji,
- Wei Liu,
- Jiaojiao Xu,
- Bo Liu,
- Xuemei Wang,
- Yao Zhang,
- Qiong Yan,
- Hui Liu,
- Xiaomei Chen,
- Shuhua Zhang,
- Yihua Wang,
- Yang Liu,
- Li Yin,
- Yanni Liu,
- Yanqing Huang,
- Li Bian,
- Ping An,
- Xin Zhang,
- Shaoting Zhang,
- Jinhua Shao,
- Xiangman Zhang,
- Wei Rao,
- Chaoxue Zhang,
- Christoph Frank Dietrich,
- Won Kim,
- Xiaolong Qi
Affiliations
- Bingtian Dong
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
- Ruiling He
- Department of Ultrasound, Donggang Branch the First Hospital of Lanzhou University, Lanzhou, China
- Shenghong Ju
- Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nanjing, China
- Yuping Chen
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
- Ivica Grgurevic
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia
- Jianzhong Ma
- Department of General Surgery, The Third People’s Hospital of Taiyuan, Taiyuan, China
- Ying Guo
- Department of Hepatology, The Third People’s Hospital of Taiyuan, Taiyuan, China
- Huizhen Fan
- Department of Gastroenterology, Yichun People’s Hospital, Yichun, China
- Qiang Yan
- Division of HPB Section Department of General Surgery, Huzhou Central Hospital, The Affiliated Central Hospital of Huzhou University, Huzhou, China
- Chuan Liu
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
- Huixiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- Anita Madir
- Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, Zagreb, Croatia
- Kristian Podrug
- Department of Gastroenterology and Hepatology, University Hospital Center Split, Split, Croatia
- Jia Wang
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Linxue Qian
- Department of Ultrasound, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Zhengzi Geng
- Department of Ultrasound, The People’s Hospital of Linxia, Linxia, China
- Shanghao Liu
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
- Tao Ren
- Department of Gastroenterology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Sichuan, China
- Guo Zhang
- Department of Gastroenterology, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Taiyuan, China
- Kun Wang
- Department of Hepatology, The Third People’s Hospital of Taiyuan, Taiyuan, China
- Meiqin Su
- Department of Ultrasound, The Third People’s Hospital of Taiyuan, Taiyuan, China
- Fei Chen
- Department of Ultrasound, The First Hospital of Lanzhou University, Lanzhou, China
- Sumei Ma
- Department of Ultrasound, The First Hospital of Lanzhou University, Lanzhou, China
- Liting Zhang
- Department of Infectious Diseases, The First Hospital of Lanzhou University, Lanzhou, China
- Zhaowei Tong
- Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou Central Hospital, Huzhou, China
- Yonghe Zhou
- Department of Ultrasonography, Tianjin Second People’s Hospital, Tianjin, China
- Xin Li
- Department of Ultrasonography, Tianjin Second People’s Hospital, Tianjin, China
- Fanbin He
- Department of Ultrasound, The People’s Hospital of Linxia, Linxia, China
- Hui Huan
- Department of Gastroenterology, Hospital of Chengdu Office of People’s Government of Tibetan Autonomous Region, Sichuan, China
- Wenjuan Wang
- Department of Gastroenterology, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Taiyuan, China
- Yunxiao Liang
- Department of Gastroenterology, Guangxi Hospital Division of the First Affiliated Hospital, Sun Yat-sen University, Taiyuan, China
- Juan Tang
- Department of Infectious Disease, Zigong First People’s Hospital, Zigong, China
- Fang Ai
- Department of Ultrasound, Zigong First People’s Hospital, Zigong, China
- Tingyu Wang
- Department of Gastroscopy, Zigong First People’s Hospital, Zigong, China
- Liyun Zheng
- Department of Radiology, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Lishui Central Hospital, Li Shui, China
- Zhongwei Zhao
- Department of Radiology, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Lishui Central Hospital, Li Shui, China
- Jiansong Ji
- Department of Radiology, Zhejiang Key Laboratory of Imaging and Interventional Medicine, Lishui Central Hospital, Li Shui, China
- Wei Liu
- Ultrasound Diagnosis Center, Shaanxi Provincial People’s Hospital, Xi’an, China
- Jiaojiao Xu
- Ultrasound Diagnosis Center, Shaanxi Provincial People’s Hospital, Xi’an, China
- Bo Liu
- Ultrasound Diagnosis Center, Shaanxi Provincial People’s Hospital, Xi’an, China
- Xuemei Wang
- Department of Ultrasound, Ditan Hospital, Capital Medical University, Beijing, China
- Yao Zhang
- Department of Ultrasound, Ditan Hospital, Capital Medical University, Beijing, China
- Qiong Yan
- Department of Gastroenterology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Hui Liu
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Xiaomei Chen
- Department of Ultrasound, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Shuhua Zhang
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China
- Yihua Wang
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China
- Yang Liu
- Department of Ultrasound, North China University of Science and Technology Affiliated Hospital, Tangshan, China
- Li Yin
- Department of Ultrasound, Jincheng People’s Hospital, Jincheng, China
- Yanni Liu
- Department of Ultrasound, Jincheng People’s Hospital, Jincheng, China
- Yanqing Huang
- Department of Ultrasound, Jincheng People’s Hospital, Jincheng, China
- Li Bian
- Department of Hepatology, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Ping An
- Department of Hepatology, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Xin Zhang
- Department of Hepatology, The Sixth People’s Hospital of Shenyang, Shenyang, China
- Shaoting Zhang
- Sensetime Research, Shanghai, China
- Jinhua Shao
- Wuxi Hisky Medical Technologies Co., Ltd., Wuxi, China
- Xiangman Zhang
- Department of Medical and Marketing, Suzhou Hengrui Medical Devices Co., Ltd., Suzhou, China
- Wei Rao
- Shenzhen New Industries Biomedical Engineering Co., Ltd., Shenzhen, China
- Chaoxue Zhang
- Department of Ultrasound, The First Affiliated Hospital of Anhui Medical University, Hefei, China
- Christoph Frank Dietrich
- Department General Internal Medicine (DAIM), Hospitals Hirslanden Bern Beau Site, Salem and Permanence, Bern, Switzerland
- Won Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Boramae Medical Center, Seoul, Korea
- Xiaolong Qi
- Liver Disease Center of Integrated Traditional Chinese and Western Medicine, Department of Radiology, Zhongda Hospital, Medical School, Southeast University, Nurturing Center of Jiangsu Province for State Laboratory of AI Imaging & Interventional Radiology (Southeast University), Basic Medicine Research and Innovation Center of Ministry of Education, Zhongda Hospital, Southeast University, State Key Laboratory of Digital Medical Engineering, Nanjing, China
- DOI
- https://doi.org/10.3350/cmh.2024.0898
- Journal volume & issue
-
Vol. 31,
no. 3
pp. 881 – 898
Abstract
Background/Aims A large percentage of patients undergoing esophagogastroduodenoscopy (EGD) screening do not have esophageal varices (EV) or have only small EV. We evaluated a large, international, multicenter cohort to develop a novel score, termed FIB-4plus, by combining the fibrosis-4 (FIB-4) score, liver stiffness measurement (LSM), and spleen stiffness measurement (SSM) to identify high-risk EV (HRV) in compensated cirrhosis. Methods This international cohort study involved patients with compensated cirrhosis from 17 Chinese hospitals and one Croatian institution (NCT04546360). Two-dimensional shear wave elastography-derived LSM and SSM values, and components of the FIB-4 score (i.e., age, aspartate aminotransferase, alanine aminotransferase, and platelet count [PLT]) were combined using machine learning algorithms (logistic regression [LR] and extreme gradient boosting [XGBoost]) to develop the LR-FIB-4plus and XGBoost-FIB-4plus models, respectively. Shapley Additive exPlanations method was used to interpret the model predictions. Results We analyzed data from 502 patients with compensated cirrhosis who underwent EGD screening. The XGBoost-FIB-4plus score demonstrated superior predictive performance for HRV, with an area under the receiver operating characteristic curve (AUROC) of 0.927 (95% confidence interval [CI] 0.897–0.957) in the training cohort (n=268), and 0.919 (95% CI 0.843–0.995) and 0.902 (95% CI 0.820–0.984) in the first (n=118) and second (n=82) external validation cohorts, respectively. Additionally, the XGBoost-FIB-4plus score exhibited high AUROC values for predicting EV across all cohorts. The FIB-4plus score outperformed the individual parameters (LSM, SSM, PLT, and FIB-4). Conclusions The FIB-4plus score effectively predicted EV and HRV in patients with compensated cirrhosis, providing clinicians with a valuable tool for optimizing patient management and outcomes.
Keywords
