The Saudi Journal of Gastroenterology (Jan 2021)

Development and validation of a nomogram for predicting varices needing treatment in compensated advanced chronic liver disease: A multicenter study

  • Jitao Wang,
  • Wenxin Wei,
  • Zhihui Duan,
  • Jinlong Li,
  • Yanna Liu,
  • Chuan Liu,
  • Liting Zhang,
  • Qingge Zhang,
  • Shengyun Zhou,
  • Kunpeng Zhang,
  • Fengxiao Gao,
  • Xiaojuan Wang,
  • Yong Liao,
  • Dan Xu,
  • Yifei Huang,
  • Shuai Wang,
  • Weiling Hu,
  • Hua Mao,
  • Ming Xu,
  • Tong Dang,
  • Bin Wu,
  • Li Yang,
  • Dengxiang Liu,
  • Xiaolong Qi

DOI
https://doi.org/10.4103/sjg.sjg_22_21
Journal volume & issue
Vol. 27, no. 6
pp. 376 – 382

Abstract

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Background: Only a small proportion of patients with compensated advanced chronic liver disease (cACLD) had varices needing treatment (VNT) after recommended esophagogastroduodenoscopy (EGD) screening. We aimed to create a non-invasive nomogram based on routine tests to detect VNT in cACLD patients. Methods: The training cohort included 162 cACLD patients undergoing EGD in a university hospital, between January 2014 and September 2019. A nomogram was developed based on the independent predictors of VNT, selected using a multivariate logistic regression analysis. Thirty-three patients from eight university hospitals were prospectively enrolled as validation cohort between December 2018 and December 2019. Results: The prevalence of VNT was 32.7% (53/162) and 39.4% (13/33) in training and validation cohorts, respectively. The univariate analysis identified six risk factors for VNT. On the multivariate analysis, four of them, i.e., gallbladder wall thickness (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 0.98-1.56), spleen diameter (OR: 1.02; 95% CI: 1.00-1.04), platelet count (OR: 0.98; 95% CI: 0.97-0.99), and international normalized ratio (OR: 0.58; 95% CI: 0.06-5.84) were independently associated with VNT. Thus, a nomogram based on the four above - mentioned variables was developed, and showed a favorable performance for detecting VNT, with an area under receiver operating characteristic curve of 0.848 (95% CI: 0.769-0.927) in training cohort. By applying a cut-off value of 105 in validation cohort, 31.0% of EGD were safely spared with 3.4% of missed VNT. Conclusion: A nomogram based on routine clinical parameters was developed for detecting VNT and avoiding unnecessary EGD in cACLD patients.

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