Predicting colorectal adenomatous polyps in patients with chronic liver disease: A novel nomogram

doi:10.3748/wjg.v31.i2.99082

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Jan 14, 2025 (publication date) through Mar 2, 2025

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World Journal of Gastroenterology

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World J Gastroenterol. Jan 14, 2025; 31(2): 99082
Published online Jan 14, 2025. doi: 10.3748/wjg.v31.i2.99082

Table 1 Clinical and laboratory data of patients with chronic liver disease

Variables	Non-polyp (n = 347)	Colorectal polyp (n = 523)		F/H/χ²	P value
Variables	Non-polyp (n = 347)	Adenomatous (n = 249)	Non-adenomatous (n = 274)	F/H/χ²	P value
Male, n (%)	160 (46.1)^a	164 (65.9)	162 (59.1)	24.67	< 0.001
Age (year), mean ± SD	50.8 ± 11.3^a	56.08 ± 10.0	53.6 ± 9.6^a	18.662	< 0.001
BMI (kg/m²), mean ± SD	25.05 ± 3.92^a	26.50 ± 3.80	25.39 ± 3.72^a	10.846	< 0.001
Alcohol, n (%)	71 (20.5)^a	108 (43.4)	67 (24.5)^a	40.41	< 0.001
Smoking, n (%)	88 (25.4)^a	105 (42.2)	81 (29.6)^a	19.676	< 0.001
Diabetes, n (%)	79 (23.0)	74 (29.7)	72 (26.4)	3.4	0.183
Hypertension, n (%)	80 (23.1)^a	74 (29.7)	73 (26.6)^a	8.632	0.013
MS, n (%)	45 (13.0)^a	51 (20.5)	61 (22.3)	10.343	0.006
Cirrhosis, n (%)	172 (49.6)	126 (46.0)	113 (45.4)	1.272	0.529
FPG (mmol/L), mean ± SD	5.9 ± 1.6^a	6.4 ± 2.5	6.1 ± 1.7	4.017	0.018
HDL (mmol/L), mean ± SD	1.3 ± 0.4^a	1.2 ± 0.3	1.3 ± 0.5^a	4.103	0.017
CHO (mmol/L), median (IQR)	4.56 (3.88, 5.39)	4.51 (3.78, 5.35)	4.51 (3.79, 5.63)	1.056	0.59
TG (mmol/L), mean ± SD	1.3 ± 1.2	1.4 ± 0.6	1.4 ± 1.2	0.579	0.561
LDL (mmol/L), mean ± SD	2.8 ± 0.8	2.9 ± 0.9	2.9 ± 1.0	1.745	0.175
PLT (10⁹/L), median (IQR)	161.00 (103.00, 203.00)	153.00 (93.00, 213.00)	168.50 (112.00, 231.25)	5.841	0.054
TP (g/L), mean ± SD	71.7 ± 7.7	71.3 ± 8.1	70.4 ± 8.4	1.964	1.141
ALB (g/L), mean ± SD	41.4 ± 5.8	39.9 ± 6.5	40.2 ± 6.0	4.148	0.016
SI (μmol/L), mean ± SD	20.8 ± 9.4^a	23.6 ± 11.7	24.5 ± 13.6^a	11.607	< 0.001
SF (μg/L), median (IQR)	125.00 (60.00, 247.00)^a	215.00 (101.00, 356.50)	174.00 (79.75, 363.50)^a	29.928	< 0.001
TRF (g/L), median (IQR)	2.55 (2.22, 3.17)	2.57 (2.20, 3.17)	2.56 (2.31, 3.22)	0.3	0.985
TSH (mIU/L), mean ± SD	2.6 ± 3.5^a	2.1 ± 1.3	2.2 ± 1.7^a	4.5	0.011
FT4 (pmol/L), mean ± SD	16.7 ± 13.0	17.6 ± 7.0	19.7 ± 9.8	2.829	0.06
FT3 (pmol/L), mean ± SD	4.9 ± 1.3	5.0 ± 0.7	5.1 ± 1.7	0.955	0.382
ALT (IU/L), median (IQR)	30.00 (18.3, 65.3)	37.00 (21.4, 70.10)	34.85 (20.55, 72.60)	1.087	0.336
AST (IU/L), median (IQR)	31.80 (21.70, 62.20)	36.70 (23.30, 68.77)	34.85 (22.00, 70.62)	3.411	0.182
GGT (IU/L), median (IQR)	52.90 (23.00, 96.50)^a	57.60 (28.60, 142.00)	59.00 (25.97, 189.07)	7.632	0.022

^aP < 0.05 vs adenomatous polyp.

BMI: Body mass index; MS: Metabolic syndrome; FPG: Fasting plasma glucose; HDL: High-density lipoprotein; CHO: Cholesterol; TG: Triacylglycerol; LDL: Low-density lipoprotein; PLT: Platelet count; TP: Total protein; ALB: Albumin; SI: Serum iron; SF: Serum ferritin; TRF: Transferrin; TSH: Thyroid-stimulating hormone; FT3: Free T3; FT4: Free T4; ALT: Alanine aminotransferase; AST: Aspartate transaminase; GGT: Gamma-glutamyl transferase; IQR: Interquartile range.

Table 2 Baseline characteristics of adenomatous polyp cohort in training and validation group

Variables	Total (n = 596)	Training group (n = 432)	Validation group (n = 164)	χ²/t/Z	P value
Male, n (%)	324 (54.4)	90 (54.9)	234 (54.2)	0.024	0.876
Age (year), mean ± SD	53.02 ± 11.14	53.04 ± 11.24	52.96 ± 10.91	0.089	0.929
BMI (kg/m²), mean ± SD	25.66 ± 3.94	25.78 ± 3.94	25.31 ± 3.93	1.323	0.186
Alcohol, n (%)	179 (30.0)	127 (29.4)	52 (31.7)	0.302	0.583
Smoking, n (%)	193 (32.4)	145 (33.6)	48 (29.3)	1.002	0.317
Diabetes, n (%)	154 (25.8)	120 (27.8)	34 (20.7)	3.080	0.079
Hypertension, n (%)	165 (27.7)	120 (27.8)	45 (27.4)	0.007	0.934
MS, n (%)	96 (16.1)	69 (16.0)	27 (16.5)	0.021	0.884
Cirrhosis, n (%)	285 (47.8)	215 (49.8)	70 (42.7)	2.392	0.122
FPG (mmo/L), mean ± SD	6.15 ± 2.07	6.23 ± 2.16	5.93 ± 1.85	-1.573	0.116
HDL (mmo/L), mean ± SD	1.33 ± 0.40	1.33 ± 0.41	1.33 ± 0.38	0.105	0.916
CHO (mmo/L), median (IQR)	4.54 (3.82, 5.38)	4.57 (3.81, 5.40)	4.41 (3.85, 5.41)	-0.714	0.458
TG (mmo/L), mean ± SD	1.42 ± 1.12	1.44 ± 1.22	1.35 ± 0.82	-0.826	0.409
LDL (mmo/L), mean ± SD	2.81 ± 0.90	2.75 ± 0.82	2.83 ± 0.93	-0.979	0.382
TP (g/L), mean ± SD	71.54 ± 7.98	71.29 ± 7.76	72.19 ± 8.51	1.239	0.216
ALB (g/L), mean ± SD	40.75 ± 6.14	40.83 ± 6.07	40.52 ± 6.34	-0.551	0.582
SI (μmol/L), mean ± SD	22.36 ± 10.67	22.37 ± 10.15	22.33 ± 11.97	-0.040	0.968
SF (ug/L), median (IQR)	165.00 (70.25, 303.25)	163.00 (76.00, 304.00)	174.00 (54.50, 295.00)	-0.721	0.471
TRF (g/L), mean ± SD	2.75 ± 0.89	2.75 ± 0.91	2.76 ± 0.83	0.203	0.840
TSH (mIU/L), median (IQR)	1.85 (1.33, 2.83)	1.94 (1.30, 2.89)	1.72 (1.34, 2.66)	-1.435	0.151
FT4 (pmol/L), mean ± SD	17.10 ± 14.18	17.31 ± 9.77	16.57 ± 9.62	-0.698	0.485
FT3 (pmol/L), mean ± SD	4.98 ± 1.00	5.01 ± 1.02	4.90 ± 0.94	-1.245	0.214
ALT (IU/L), median (IQR)	33.20 (19.40, 78.57)	32.20 (19.10, 76.57)	34.75 (19.65, 79.25)	-0.610	0.542
AST (IU/L), median (IQR)	33.75 (22.35, 72.47)	33.75 (22.02, 65.60)	34.10 (22.62, 78.75)	-0.491	0.624
GGT (IU/L), median (IQR)	53.85 (24.35, 116.77)	54.55 (24.97, 100.57)	50.05 (22.07, 163.45)	-0.274	0.708

Table 3 The multivariate logistic regression analyses of the risk for model

Variables	B	Standard error	Wals	P value	Expect (B)	95%CI
Age	0.066	0.012	30.283	< 0.001	1.069	1.044-1.094
Male	1.169	0.268	8.971	< 0.001	3.217	1.902-5.444
BMI	0.093	0.035	7.113	0.008	1.098	1.025-1.175
Alcohol consumption	0.671	0.310	4.677	0.031	1.956	1.065-3.593
OLDs-MASLD	0.833	0.259	10.312	0.001	2.301	1.384-3.826
SF	0.001	0.001	2.627	0.047	1.001	1.000-1.010
Smoking	0.311	0.293	1.129	0.288	1.365	0.769-2.423
ALB	0.033	0.021	2.499	0.114	0.968	0.929-1.008
TSH	0.160	0.083	3.738	0.053	0.852	0.724-1.002

CI: Confidence interval; BMI: Body mass index; OLDs-MASLD: Other liver diseases overlapping metabolic dysfunction associated steatotic liver disease; SF: Serum ferritin; ALB: Albumin; TSH: Thyroid stimulating hormone.

Table 4 Differences of etiology in colorectal polyps in chronic liver disease, n (%)

Etiology	Non-polyps	Non-adenomatous polyps	Adenomatous polyps	P value
OLDs (n = 815)
OLDs-MASLD	96 (27.2)^a	133 (37.7)^a	124 (35.1)	< 0.001
No MASLD	225 (48.7)^a	129 (27.9)^a	108 (23.4)	< 0.001
Pure MASLD (n = 55)
Pure MASLD	26 (47.3)^a	12 (21.8)	17 (30.9)	< 0.001
OLDs-MASLD	96 (27.2)^a	133 (37.7)	124 (35.1)	< 0.001
HBV (n = 417)
MASLD	47 (28.8)^a	69 (42.3)^a	47 (28.8)	< 0.001
No MASLD	134 (52.8)^a	65 (25.6)^a	55 (21.6)	< 0.001
AIH (n = 44)
MASLD	7 (25.9)	13 (48.1)	7 (25.9)	0.046
No MASLD	8 (47.0)	2 (11.8)	7 (41.2)	0.046
ALD (n = 124)
MASLD	8 (14.8)^a	13 (24.1)^a	33 (61.1)	< 0.001
No MASLD	25 (35.7)^a	28 (40.0)^a	17 (24.3)	< 0.001
HCV (n = 108)
MASLD	17 (30.4)	20 (35.7)	19 (33.9)	0.090
No MASLD	25 (48.1)	10 (19.2)	17 (32.7)	0.090
PBC (n = 37)
MASLD	5 (33.3)	6 (40.0)	4 (26.7)	0.570
No MASLD	10 (45.5)	9 (40.9)	3 (13.6)	0.570
DILI (n = 75)
MASLD	12 (31.6)	12 (31.6)	14 (36.8)	0.327
No MASLD	16 (43.2)	13 (35.1)	8 (21.6)	0.327

^aP < 0.05 vs adenomatous polyps.

This study included 10 cases of other liver diseases, such as Budd-Chiari syndrome and genetic metabolic liver diseases, which were excluded from detailed analysis due to their small sample size. OLDs: Other liver diseases; MASLD: Metabolic dysfunction-associated steatotic liver disease; HBV: Hepatitis B virus; HCV: Hepatitis C virus; ALD: Alcoholic liver disease; AIH: Autoimmune hepatitis; PBC: Primary biliary cholangitis; DILI: Drug-induced liver injury.

Citation: Li YQ, Kuai WT, Chen L, Zeng MH, Tao XM, Han JX, Wang YK, Xu LX, Ge LY, Liu YG, Li S, Xu L, Mi YQ. Predicting colorectal adenomatous polyps in patients with chronic liver disease: A novel nomogram. World J Gastroenterol 2025; 31(2): 99082
URL: https://www.wjgnet.com/1007-9327/full/v31/i2/99082.htm
DOI: https://dx.doi.org/10.3748/wjg.v31.i2.99082