A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis

Beom Kyung Kim, Kwang Hyub Han, Jun Yong Park, Sang Hoon Ahn, Ja Kyung Kim, Yong Han Paik, Kwan Sik Lee, Chae Yoon Chon, Do Young Kim

Research output: Contribution to journalArticle

119 Citations (Scopus)

Abstract

Objectives: Periodic endoscopic screening for esophageal varices (EVs) and prophylactic treatment for high-risk EVs ((HEVs); (1) medium/large EVs and (2) small EVs with red sign or decompensated cirrhosis) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may safely avoid endoscopy. We developed and validated a new liver stiffness measurement (LSM)-based prediction model for HEVs.Methods: We prospectively enrolled 280 consecutive B-viral cirrhosis patients from 2005 to 2007 (training set) and 121 from 2007 to 2008 (validation set). All underwent laboratory workups, endoscopy, LSM, and ultrasonography. For detection of HEVs, univariate and multivariate analysis were performed, using X 2-test/t-test and logistic regression, respectively. A prediction model was derived from multivariate predictors.Results: In the training set, 90 had HEVs, and multivariate analysis showed significant differences in LSM, spleen diameter, and platelet count between patients with and without HEVs. We developed LSM-spleen diameter to platelet ratio score (LSPS): LSM × spleen diameter/platelet count. The area under the receiver-operating characteristic curve (AUROC) in the training set was 0.954. At LSPS3.5, 94.0% negative predictive value (NPV) was provided (184 patients), whereas 94.2% positive predictive value (PPV) was achieved (69 patients) at LSPS5.5. Overall, the likelihood of HEVs was correctly diagnosed in 253 patients (90.3%). Its predictive values were maintained at similar accuracy in subsequent validation set (AUROC0.953; 94.7% NPV/93.3% PPV at cutoff 3.5/5.5, respectively). Conclusions: LSPS is a reliable, noninvasive method for detection of HEVs. Patients with LSPS3.5 may avoid endoscopy safely, whereas those with LSPS5.5 should be considered for appropriate prophylactic treatments.

Original languageEnglish
Pages (from-to)1382-1390
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume105
Issue number6
DOIs
Publication statusPublished - 2010 Jun 1

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Esophageal and Gastric Varices
Liver Cirrhosis
Liver
Endoscopy
Spleen
Platelet Count
Fibrosis
Multivariate Analysis
ROC Curve
Ultrasonography
Blood Platelets
Logistic Models
Therapeutics

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

@article{1ff223340e7e41e5919321c460f1380c,
title = "A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis",
abstract = "Objectives: Periodic endoscopic screening for esophageal varices (EVs) and prophylactic treatment for high-risk EVs ((HEVs); (1) medium/large EVs and (2) small EVs with red sign or decompensated cirrhosis) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may safely avoid endoscopy. We developed and validated a new liver stiffness measurement (LSM)-based prediction model for HEVs.Methods: We prospectively enrolled 280 consecutive B-viral cirrhosis patients from 2005 to 2007 (training set) and 121 from 2007 to 2008 (validation set). All underwent laboratory workups, endoscopy, LSM, and ultrasonography. For detection of HEVs, univariate and multivariate analysis were performed, using X 2-test/t-test and logistic regression, respectively. A prediction model was derived from multivariate predictors.Results: In the training set, 90 had HEVs, and multivariate analysis showed significant differences in LSM, spleen diameter, and platelet count between patients with and without HEVs. We developed LSM-spleen diameter to platelet ratio score (LSPS): LSM × spleen diameter/platelet count. The area under the receiver-operating characteristic curve (AUROC) in the training set was 0.954. At LSPS3.5, 94.0{\%} negative predictive value (NPV) was provided (184 patients), whereas 94.2{\%} positive predictive value (PPV) was achieved (69 patients) at LSPS5.5. Overall, the likelihood of HEVs was correctly diagnosed in 253 patients (90.3{\%}). Its predictive values were maintained at similar accuracy in subsequent validation set (AUROC0.953; 94.7{\%} NPV/93.3{\%} PPV at cutoff 3.5/5.5, respectively). Conclusions: LSPS is a reliable, noninvasive method for detection of HEVs. Patients with LSPS3.5 may avoid endoscopy safely, whereas those with LSPS5.5 should be considered for appropriate prophylactic treatments.",
author = "Kim, {Beom Kyung} and Han, {Kwang Hyub} and Park, {Jun Yong} and Ahn, {Sang Hoon} and Kim, {Ja Kyung} and Paik, {Yong Han} and Lee, {Kwan Sik} and Chon, {Chae Yoon} and Kim, {Do Young}",
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A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis. / Kim, Beom Kyung; Han, Kwang Hyub; Park, Jun Yong; Ahn, Sang Hoon; Kim, Ja Kyung; Paik, Yong Han; Lee, Kwan Sik; Chon, Chae Yoon; Kim, Do Young.

In: American Journal of Gastroenterology, Vol. 105, No. 6, 01.06.2010, p. 1382-1390.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis

AU - Kim, Beom Kyung

AU - Han, Kwang Hyub

AU - Park, Jun Yong

AU - Ahn, Sang Hoon

AU - Kim, Ja Kyung

AU - Paik, Yong Han

AU - Lee, Kwan Sik

AU - Chon, Chae Yoon

AU - Kim, Do Young

PY - 2010/6/1

Y1 - 2010/6/1

N2 - Objectives: Periodic endoscopic screening for esophageal varices (EVs) and prophylactic treatment for high-risk EVs ((HEVs); (1) medium/large EVs and (2) small EVs with red sign or decompensated cirrhosis) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may safely avoid endoscopy. We developed and validated a new liver stiffness measurement (LSM)-based prediction model for HEVs.Methods: We prospectively enrolled 280 consecutive B-viral cirrhosis patients from 2005 to 2007 (training set) and 121 from 2007 to 2008 (validation set). All underwent laboratory workups, endoscopy, LSM, and ultrasonography. For detection of HEVs, univariate and multivariate analysis were performed, using X 2-test/t-test and logistic regression, respectively. A prediction model was derived from multivariate predictors.Results: In the training set, 90 had HEVs, and multivariate analysis showed significant differences in LSM, spleen diameter, and platelet count between patients with and without HEVs. We developed LSM-spleen diameter to platelet ratio score (LSPS): LSM × spleen diameter/platelet count. The area under the receiver-operating characteristic curve (AUROC) in the training set was 0.954. At LSPS3.5, 94.0% negative predictive value (NPV) was provided (184 patients), whereas 94.2% positive predictive value (PPV) was achieved (69 patients) at LSPS5.5. Overall, the likelihood of HEVs was correctly diagnosed in 253 patients (90.3%). Its predictive values were maintained at similar accuracy in subsequent validation set (AUROC0.953; 94.7% NPV/93.3% PPV at cutoff 3.5/5.5, respectively). Conclusions: LSPS is a reliable, noninvasive method for detection of HEVs. Patients with LSPS3.5 may avoid endoscopy safely, whereas those with LSPS5.5 should be considered for appropriate prophylactic treatments.

AB - Objectives: Periodic endoscopic screening for esophageal varices (EVs) and prophylactic treatment for high-risk EVs ((HEVs); (1) medium/large EVs and (2) small EVs with red sign or decompensated cirrhosis) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may safely avoid endoscopy. We developed and validated a new liver stiffness measurement (LSM)-based prediction model for HEVs.Methods: We prospectively enrolled 280 consecutive B-viral cirrhosis patients from 2005 to 2007 (training set) and 121 from 2007 to 2008 (validation set). All underwent laboratory workups, endoscopy, LSM, and ultrasonography. For detection of HEVs, univariate and multivariate analysis were performed, using X 2-test/t-test and logistic regression, respectively. A prediction model was derived from multivariate predictors.Results: In the training set, 90 had HEVs, and multivariate analysis showed significant differences in LSM, spleen diameter, and platelet count between patients with and without HEVs. We developed LSM-spleen diameter to platelet ratio score (LSPS): LSM × spleen diameter/platelet count. The area under the receiver-operating characteristic curve (AUROC) in the training set was 0.954. At LSPS3.5, 94.0% negative predictive value (NPV) was provided (184 patients), whereas 94.2% positive predictive value (PPV) was achieved (69 patients) at LSPS5.5. Overall, the likelihood of HEVs was correctly diagnosed in 253 patients (90.3%). Its predictive values were maintained at similar accuracy in subsequent validation set (AUROC0.953; 94.7% NPV/93.3% PPV at cutoff 3.5/5.5, respectively). Conclusions: LSPS is a reliable, noninvasive method for detection of HEVs. Patients with LSPS3.5 may avoid endoscopy safely, whereas those with LSPS5.5 should be considered for appropriate prophylactic treatments.

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