Diagnostic non-invasive model of large risky esophageal varices in cirrhotic hepatitis C virus patients

Table 1 Patients characteristicsn n (%)

Variables	All patients (n = 124)	No varices (n = 50)	Small varices (n = 28)	Large varices (n = 46)	P value
Age, mean ± SD	56.52 ± 5.759	57.28 ± 4.513	58.57 ± 3.072	54.43 ± 7.423	0.005
Gender
Female	52 (41.9)	24 (48.0)	12 (42.9)	16 (34.8)	0.421
Male	72 (58.1)	26 (52)	16 (57.1)	30 (65.2)
Laboratory data (mean ± SD)
Serumalbumin (g/dL)	3.329 ± 0.43	3.452 ± 0.404	3.271 ± 0.352	3.229 ± 0.474	0.028
Serum bilirubin (mg/dL)	1.312 ± 0.572	1.093 ± 0.534	1.414 ± 0.591	1.489 ± 0.532	0.001
INR	1.326 ± 0.238	1.249 ± 0.225	1.431 ± 0.24	1.347 ± 0.226	0.003
Serum creatinine (mg/dL)	0.999 ± 0.179	0.956 ± 0.169	0.994 ± 0.178	1.047 ± 0.180	0.044
AST (IU/L)	68.00 ± 40.086	65.84 ± 44.072	63.71 ± 22.993	72.96 ± 43.797	0.561
ALT (IU/L)	55.18 ± 23.607	51.84 ± 19.844	57.43 ± 24.848	57.43 ± 26.519	0.436
Platelet count (cells/mm3)	152.94 ± 22.012	145.96 ± 20.833	156.5 ± 27.941	1548.35 ± 17.071	0.001
AFP (ng/mL)	2.687 ± 2.687	3.646 ± 60.527	5.868 ± 1.854	3.274 ± 811.945	0.064
Clinical data
Spleen size (mm)	152.94 ± 22.012	145.96 ± 20.833	156.5 ± 27.941	158.35 ± 17.071	0.013
Presence of ascites					0.017
Mild (respo-nsive)	34 (27.5)	6 (12)	8 (28.5)	20 (43.4)
No	90 (72.6)	44 (88)	20 (71.4)	26 (56.5)
MELD score (mean ± SD)	1.103 ± 2.828	9.852 ± 2.480	1.2 ± 2.55	1.171 ± 2.942	0.001
History of encepha-lopathy
No	124 (100)	50 (100)	28 (100)	46 (100)
Yes	0 (0)	0 (0)	0 (0)	0 (0)
Child Pugh Classification
A	78 (62.9)	42 (84.3)	18 (64.3)	18 (39.1)	0.001
B	46 (37.1)	8 (16)	10 (35.7)	28 (60.9)

AST: Aspartate transaminase; ALT: Alanine aminotransferase; AFP: Alpha fetal protein.

Table 2 Comparison of multiple variables between patients groups (mean ± SD) n (%)

Variables	All patients (n = 124)	No varices (n = 50)	Small varices (n = 28)	Large varices (n = 46)	P value
FIB-4	5.526 ± 3.239	4.432 ± 2.334	4.814 ± 2.457	7.149 ± 3.844	0.001
APRI	1.836 ± 1.256	1.408 ± 0.84	1.606 ± 1.02	2.442 ± 1.519	0.001
PC/SD	722.235 ± 316.5	891.133 ± 317.027	765.016 ± 326.324	512.611 ± 150.784	0.001
PVD by CT	14.116 ± 2.967	13.142 ± 2.959	14.929 ± 3.366	14.639	0.012
SVD by CT	10.903 ± 2.857	10.42 ± 2.989	11.071 ± 3.62	11.326 ± 2.063	0.284
Coronary vein ≥ 7 mm by CT	16 (12.7)	4 (8.0)	4 (14.29)	8 (17.39)	0.026
Lienorenal shunt ≥ 12 mm by CT	8 (6.45)	8 (28.57)	0 (0)	0 (0)	0.006
Presence of varices in CT					0.001
Yes	74 (59.7)	4 (8.0)	28 (100)	42 (91.3)
No	50 (40.3)	46 (92.0)	0 (0)	4 (8.7)

FIB-4: Fibrosis-4 score; APRI: Aminotransferase-to-platelet ratio index; PC/SD: Platelet count/splenic diameter ratio; PVD: Portal vein diameter; SVD: Splenic vein diameter; CT: Computed tomography.

Table 3 Sensitivity and specificity of noninvasive parameters

Parameters	Sensitivity	Specificity	AUC	95%CI	Cut-off	Significance
FIB-4	71.70%	50%	0.585	0.442-0.728	3.13	0.222
APRI	63%	46.40%	0.558	0.417-0.699	1.083	0.406
PC/SD	75%	47.80%	0.550	0.412-0.688	806.93	0.472
PVD by CT	71%	37%	0.560	0.425-0.695	12.5	0.396

FIB-4: Fibrosis-4 score; APRI: Aminotransferase-to-platelet ratio index; PC/SD: Platelet count/splenic diameter ratio; PVD: Portal vein diameter; CT: Computed tomography; AUC: Area under the curve.

Table 4 Diagnostic model of large varices

Variables in the Equation
		B	SE	Wald	df	Sig.	Exp (B)	95.0%CI for Exp (B)
								Lower	Upper
Step 11	APRI	-0.444	0.813	0.298	1	0.585	0.641	0.130	3.155
	FIB-4	0.236	0.340	0.484	1	0.487	1.267	0.651	2.465
	PVD by CT	-0.257	0.123	4.398	1	0.036	0.773	0.608	0.983
	PC/SD	-0.006	0.002	8.327	1	0.004	0.994	0.990	0.998
	Coronary vein diameter by CT	-0.853	0.687	1.544	1	0.214	0.426	0.111	1.637
	Lieno-renal vein diameter by CT	-0.747	0.805	0.860	1	0.354	0.474	0.098	2.297
	Constant	10.125	3.838	6.959	1	0.008	2.497E4

¹Variable(s) entered: APRI, FIB-4, PVD by CT, PC/SD, coronary vein by CT, lieno-renal shunt diameter by CT. FIB-4: Fibrosis-4 score; APRI: Aminotransferase-to-platelet ratio index; PC/SD: Platelet count/splenic diameter ratio; PVD: Portal vein diameter; CT: Computed tomography; Exp: Exponential; SE: Standard error.

Table 5 Diagnostic model of large varices

Variables in the equation
		B	SE	Wald	df	Sig.	Exp (B)	95%CI for Exp (B)
								Lower	Upper
PC/SD1	PC/SD	-0.005	0.001	10.721	1	0.001	0.995	0.992	0.998
	Constant	3.457	0.926	13.935	1	0.000	31.707
PVD by CT and PC/SD2	PVD by CT	-0.256	0.116	4.879	1	0.027	0.774	0.617	0.972
	PC/SD	-0.006	0.002	13.057	1	0.000	0.994	0.990	0.997
	Constant	8.155	2.465	10.942	1	0.001	3.480E3

¹Variable entered: PC/SD;

²Variable entered: PVD by CT and PC/SD. PC/SD: Platelet count/splenic diameter ratio; PVD: Portal vein diameter; CT: Computed tomography; Exp: Exponential; SE: Standard error.

Table 6 Diagnostic model of large varices

Classification table1
	Observed		Predicted
			ROC size		Percentage correct
			1	2
PC/SD	ROC size	1	12	16	42.9%
		2	4	42	91.3%
	Overall percentage				73%
PC/SD plus PVD by CT	ROC size	1	16	12	57.1%
		2	6	40	87%
	Overall percentage				75.7%

¹The cut-off value is 0.500. PC/SD: Platelet count/splenic diameter ratio; PVD: Portal vein diameter; CT: Computed tomography; ROC: Receiver operating characteristic curve.