Noninvasive methods for prediction of esophageal varices in pediatric patients with portal hypertension

Table 1 Univariate analysis for esophageal varices

Variables	Varices (n = 71)	No varices (n = 32)	P value
Age (yr)	9.1 ± 4.9	8.5 ± 4.4	0.530
AST (U/L)	87 (51-158)	68 (36-178)	0.417
ALT (U/L)	78 (40-141)	54 (22-160)	0.197
INR	1.2 (1.1-1.4)	1.1 (1.1-1.3)	0.066
Bilirubin (mg/dL)	1.4 (0.8-2.4)	0.6 (0.4-2.2)	0.016
Albumin (g/dL)	3.8 ± 0.6	4.1 ± 0.7	0.077
Creatinine (mg/dL)	0.5 ± 0.2	0.5 ± 0.2	0.686
Splenomegaly	64 (95.5%)	22 (73.3%)	0.001
Spleen size (cm)	14.6 ± 3.3 (n = 65)	12.2 ± 2.7 (n = 24)	0.001
Spleen size z score	6.3 ± 3.2 (n = 65)	3.7 ± 2.6 (n = 24)	0.000
Platelets (103/μL)	102 ± 50.8	195 ± 85.2	0.000
Encephalopathy(1/2/3)1	31/0/0	68/3/0	0.245
Ascites (1/2/3)2	31/0/1	59/9/3	0.100
Model of end-stage liver disease	6.6 ± 4.6 (n = 23)	3.6 ± 7.1 (n = 8)	0.290
Pediatric end-stage liver disease	-1.3 ± 8.6 (n = 48)	-2.2 ± 10.2 (n = 24)	0.708
Child-Pugh A/B/C	35/31/5	22/8/2	0.169
Child score	7.0 ± 1.4	6.6 ± 1.3	0.074
Clinical prediction rule	103.6 ± 17.5 (n = 65)	121.1 ± 21.1 (n = 24)	0.001
Platelets/spleen size z score	16.7 (7.9-31.1)	47.1 (27.2-123.3)	0.000
APRI	2.3 (1.0-3.7)	1.0 (0.3-2.3)	0.001
Platelets/spleen size	0.7 (0.4-1.1) (n = 65)	1.3 (0.8-2.2) (n = 24)	0.000
Risk score	1.2 ± 2.6	-1.6 ± 2.9	0.000

¹Determined clinically or by electroencephalogram: 1 = none; 2 = grade 1 or 2; 3 = grade 3 or 4;

²Determined clinically or by ultrasound: 1 = no ascites; 2 = controlled or mild; 3 = moderate or tense. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; INR: International normalized ratio; APRI: Aspartate aminotransferase to platelet ratio index.

Table 2 Odds ratios for esophageal varices

Variables	OR1	95%CI	P value
CPR < 115	7.99	1.45-43.82	0.017
CPR < 114	20.74	2.66-161.50	0.004
Platelets/spleen size z score < 25	4.27	0.90-20.26	0.067
Platelets/spleen size < 1	2.20	0.65-7.43	0.203
Platelets	0.98	0.97-0.99	0.016
Platelets < 115	3.10	0.97-9.88	0.056
Risk score > -1.2	7.47	2.06-26.99	0.002
APRI > 1.4	1.85	0.56-6.10	0.309

¹Odds ratio computed by multivariate logistic regression model. CPR: Clinical prediction rule; APRI: Aspartate aminotransferase to platelet ratio index.

Table 3 Diagnostic performance of variables as esophageal varices predictors

Variables	Sensitivity (95%CI)	Specificity (95%CI)	Positive predictive value (95%CI)	Negative predictive value (95%CI)	Positive likelihood ratio (95%CI)	Negative likelihood ratio (95%CI)
Clinical prediction rule < 115	76.6 (64.0-85.8)	70.8 (48.7-86.5)	87.5 (75.3-94.4)	53.1 (35.0-70.4)	2.63 (1.38-4.96)	0.33 (0.20-0.53)
Clinical prediction rule < 114	75.0 (62.3-84.6)	79.2 (57.3-92.0)	90.5 (78.5-96.5)	54.2 (36.8-70.8)	3.60 (1.63-7.95)	0.32 (0.20-0.49)
Platelets < 115	67.6 (55.3-77.9)	81.3 (62.9-92.1)	88.8 (76.6-95.4)	53.0 (38.4-67.2)	3.61 (1.72-7.54)	0.40 (0.28-0.56)
Platelets/spleen size z score < 25	68.8 (55.8-79.4)	79.2 (57.3-92.0)	89.8 (76.9-96.2)	48.7 (32.7-64.9)	3.30 (1.48-7.32)	0.39 (0.27-0.58)
Platelets/spleen size < 1	72.3 (59.6-82.3)	66.7 (44.6-83.6)	85.4 (72.8-93.0)	47.0 (30.1-64.6)	2.17 (1.20-3.89)	0.42 (0.27-0.64)
Risk score > -1.2	80.3 (67.2-89.3)	70.9 (51.7-85.1)	86.3 (75.2-93.2)	61.1 (43.5-76.4)	2.77 (1.57-4.85)	0.28 (0.17-0.45)
APRI > 1.4	63.4 (51.0-74.2)	65.6 (46.7-80.8)	80.3 (67.2-89.3)	44.7 (30.4-59.8)	1.84 (1.10-3.07)	0.56 (0.39-0.78)

APRI: Aspartate aminotransferase to platelet ratio index.