Observational Study
Copyright ©The Author(s) 2017.
World J Gastroenterol. Jul 14, 2017; 23(26): 4806-4814
Published online Jul 14, 2017. doi: 10.3748/wjg.v23.i26.4806
Table 1 Distribution of baseline characteristics by esophageal variceal status
VariableTotal (n = 139)Without EV (n = 26)With EV (n = 113)P value
Upper panel: Categorical variables2
Sex
Men109 (78.4)118 (69.2)91 (80.5)0.289
Women30 (21.6)8 (30.8)22 (19.5)
Etiology of cirrhosis0.005
Alcoholic67 (48.2)10 (38.5)57 (50.4)
HBV32 (23.0)5 (19.2)27 (23.9)
HCV8 (5.8)-8 (7.1)
Alcoholic + viral11 (7.9)1 (3.8)10 (8.8)
Other21 (15.1)10 (38.5)11 (9.7)
EV-
None26 (18.7)26 (100.0)-
SEV44 (31.7)-44 (38.9)
MEV39 (28.1)-39 (34.5)
LEV30 (21.6)-30 (26.5)
Red signs0.034
Without varices26 (18.7)22 (21.0)4 (11.8)
Yes19 (13.7)10 (9.5)9 (26.5)
No94 (67.6)73 (69.5)21 (61.8)
CTP0.047
A (5-6)43 (30.9)13 (50.0)30 (26.5)
B (7-9)63 (45.3)10 (38.5)53 (46.9)
C (10-15)33 (23.7)3 (11.5)30 (26.5)
Lower panel: Numerical variables3
Age (yr)51.5 ± 13.147.6 ± 15.452.3 ± 12.40.106
Hemoglobin (mg/dL)11.8 ± 2.311.6 ± 2.411.8 ± 2.30.916
Creatinine (mg/dL)0.89 ± 0.340.89 ± 0.440.89 ± 0.310.141
AST (UI/L)107.6 ± 156.1153.5 ± 331.697.0 ± 69.90.412
ALT (UI/L)73.1 ± 161.9125.5 ± 336.761.0 ± 78.90.742
GGT (UI/L)264.9 ± 302.7282.0 ± 389.7261.0 ± 280.90.709
Gama globulin (g/L)27.1 ± 10.326.9 ± 15.327.2 ± 8.80.310
INR1.65 ± 0.471.38 ± 0.341.71 ± 0.47< 0.001
Albumin3.19 ± 0.653.27 ± 0.713.17 ± 0.640.058
FIB-45.83 ± 5.333.98 ± 3.066.26 ± 5.640.011
Fibrosis index3.15 ± 1.302.83 ± 1.083.22 ± 1.330.012
King score82.9 ± 135.266.5 ± 137.486.7 ± 135.10.002
APRI2.63 ± 3.792.52 ± 4.742.66 ± 3.570.014
PL/SD1146 ± 7801395 ± 7841089 ± 7710.028
AST/ALT2.18 ± 1.621.93 ± 1.472.23 ± 1.660.339
MELD15.7 ± 5.213.6 ± 4.816.1 ± 5.20.027
1Absolute numbers and column percentages (in parentheses);
2P values from Fisher’s exact test;
3P values from Mann-Whitney’s U-test. AST/ALT: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio; APRI: AST to platelet ratio index; CTP: Child-Turcotte-Pugh score; EV: Esophageal varices; FIB-4: Fibrosis-4-index; GGT: Gamma glutamyltranspeptidase; HBV: Hepatitis B virus; HCV: Hepatitis C virus; INR: International normalized ratio; LEV: Large esophageal varices; MEV: Medium esophageal varices; MELD: Model for end-stage liver disease; PC/SD: Platelet count to spleen diameter; SEV: Small esophageal varices.
Table 2 Association of non-invasive markers with presence of esophageal varices in liver cirrhosis
Non-invasive markersLeft panel: Unadjusted models
Right panel: Multivariable-adjusted models2
OR (95%CI)1P1 vauleOR (95%CI)P vaule
FIB-41.18 (1.01-1.38)0.0321.57 (1.15-2.14)0.005
Fibrosis index1.25 (0.90-1.74)0.177
King score1.00 (0.99-1.01)0.501
APRI1.01 (0.90-1.14)0.866
PL/SD1.00 (0.99-1.00)0.078
AST/ALT1.15 (0.84-1.57)0.395
MELD1.11 (1.01-1.22)0.026
1Odds ratios (OR: Esophageal varices vs no esophageal varices), 95%CI and P values from binary logistic regression.
2Models adjusted for age, sex, etiology of liver cirrhosis, CTP, VPT, hemoglobin, creatinine, AST, ALT, GGT, gama globulin, INR, albumin, FIB 4, fibrosis index, king score, APRI, PL/SD, AST/ALT and MELD. All variables were entered in a backward stepwise elimination procedure with a p-value to exit set at > 0.10. Empty cells refer to the variables excluded from the multivariable-adjusted logistic regression models. AST/ALT: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4-index; MELD: Model for end-stage liver disease; PC/SD: Platelet count to spleen diameter.
Table 3 Performance of fibrosis-4-index for prediction of esophageal varices (n = 139; esophageal varices: n = 113)
Cut-offSensitivitySpecificityPPVNPVAUC (95%CI)1P value
3.2372%58%88%32%0.66 (0.54-0.78)0.011
1AUC (area under the curve) obtained from the receiver operating characteristic. FIB-4: Fibrosis-4-index; NPV: Negative predictive value; PPV: Positive predictive value.
Table 4 Baseline characteristics of patients with esophageal variceal bleeding during follow-up n (%)
Categorical variablesTotal (n =139)No EVB (n = 105)EVB (n = 34)P value
Upper panel: Categorical variables2
Sex
Men109 (78.4)180 (76.2)29 (85.3)0.341
Women30 (21.6)25 (23.8)5 (14.7)
Etiology of cirrhosis:0.762
Alcoholic67 (48.2)49 (46.7)18 (52.9)
HBV32 (23.0)23 (21.9)9 (26.5)
HCV8 (5.8)6 (5.7)2 (5.9)
Alcoholic + viral11 (7.9)9 (8.6)2 (5.9)
Other21 (15.1)18 (17.1)3 (8.8)
EV0.176
None26 (18.7)22 (21.0)4 (11.8)
SEV44 (31.7)36 (34.3)8 (23.5)
MEV39 (28.1)25 (23.8)14 (41.2)
LEV30 (21.6)22 (21.0)8 (23.5)
Red signs0.034
Without varices26 (18.7)22 (21.0)4 (11.8)
Yes19 (13.7)10 (9.5)9 (26.5)
No94 (67.6)73 (69.5)21 (61.8)
CTP0.968
A (5-6)43 (30.9)33 (31.4)10 (29.4)
B (7-9)63 (45.3)47 (44.8)16 (47.1)
C (10-15)33 (23.7)25 (23.8)8 (23.5)
Lower panel: Numerical variables3
Age (yr)51.5 ± 13.152.1 ± 13.549.7 ± 11.60.402
Hemoglobin (mg/dL)11.8 ± 2.312.0 ± 2.210.9 ± 2.50.017
PL (n/mm3)165539 ± 101181168742 ± 107419155647 ± 794590.801
Creatinine (mg/dL)0.89 ± 0.340.88 ± 0.340.92 ± 0.320.336
AST (UI/L)107.6 ± 156.1112.2 ± 175.793.4 ± 65.80.852
ALT (UI/L)73.1 ± 161.980.3 ± 189.950.6 ± 34.50.930
GGT (UI/L)264.9 ± 302.7267.1 ± 311.4258.2 ± 278.10.737
Gama globulin (g/L)27.1 ± 10.326.6 ± 9.028.6 ± 13.60.555
INR1.65 ± 0.471.65 ± 0.481.65 ± 0.430.862
Albumin3.19 ± 0.653.17 ± 0.723.25 ± 0.380.608
FIB-45.83 ± 5.335.93 ± 5.805.50 ± 3.560.881
Fibrosis index3.15 ± 1.303.13 ± 1.413.22 ± 0.840.901
King score82.9 ± 135.289.6 ± 152.262.1 ± 53.70.978
APRI2.63 ± 3.792.80 ± 4.252.13 ± 1.700.550
PL/SD1146 ± 7801189 ± 8261014 ± 6050.398
AST/ALT2.18 ± 1.622.17 ± 1.642.23 ± 1.570.628
MELD15.7 ± 5.215.5 ± 5.316.2 ± 4.80.435
1Absolute numbers and column percentages (in parentheses);
2P values from Fisher’s exact test;
3P values from Mann-Whitney’s U-test. AST/ALT: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio; APRI: AST to platelet ratio index; CTP: Child-Turcotte-Pugh score; EV: Esophageal varices; FIB-4: Fibrosis-4-index; GGT: Gamma glutamyltranspeptidase; HBV: Hepatitis B virus; HCV: Hepatitis C virus; INR: International normalized ratio; LEV: Large esophageal varices; MEV: Medium esophageal varices; MELD: Model for end-stage liver disease; PC/SD: Platelet count to spleen diameter; SEV: Small esophageal varices.
Table 5 Performance of non-invasive markers for prediction of esophageal variceal bleeding (n = 34)
Non-invasive markersCut-off valueSensitivitySpecificityAUC (95%CI)1P value
FIB-45.0253%54%0.51 (0.40-0.62)0.881
Fibrosis index3.1253%45%0.52 (0.40-0.61)0.901
King score37.1665%44%0.50 (0.40-0.60)0.978
APRI1.6659%54%0.53 (0.43-0.64)0.550
PL/SD82853%39%0.45 (0.34-0.56)0.398
AST/ALT1.7159%54%0.53 (0.42-0.64)0.628
MELD15.556%52%0.55 (0.44-0.65)0.436
1AUC (area under the curve) obtained from the receiver operating characteristic. AST/ALT: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4-index; MELD: Model for end-stage liver disease; PC/SD: Platelet count to spleen diameter.
Table 6 Performance of non-invasive markers for prediction of esophageal variceal bleeding among patients with variceal prophylactic therapy (n = 83; esophageal variceal bleeding: n = 23)
Non-invasive markersCut-off valueSensitivitySpecificityAUC (95%CI)1P value
FIB-45.0257%42%0.42 (0.28-0.56)0.257
Fibrosis index3.4357%40%0.41 (0.28-0.55)0.215
King score46.1557%28%0.39 (0.26-0.52)0.112
APRI1.6557%58%0.45 (0.32-0.57)0.439
PL/SD73652%43%0.49 (0.34-0.63)0.843
AST/ALT1.7957%58%0.53 (0.42-0.64)0.628
MELD16.557%58%0.49 (0.35-0.63)0.879
1AUC (area under the curve) obtained from the receiver operating characteristic. AST/ALT: Aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio; APRI: AST to platelet ratio index; FIB-4: Fibrosis-4-index; MELD: Model for end-stage liver disease; PC/SD: Platelet count to spleen diameter; VPT: Variceal prophylactic therapy.