Saudi Journal of Gastroenterology
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Year : 2021  |  Volume : 27  |  Issue : 6  |  Page : 376-382

Development and validation of a nomogram for predicting varices needing treatment in compensated advanced chronic liver disease: A multicenter study

1 CHESS Working Party, Xingtai Institute of Cancer Control, Xingtai People's Hospital, Xingtai; CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
2 Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
3 CHESS Working Party, Xingtai Institute of Cancer Control, Xingtai People's Hospital, Xingtai, China
4 CHESS Center, Institute of Portal Hypertension, The First Hospital of Lanzhou University, Lanzhou, China
5 Department of Hepatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
6 Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China
7 Department of Gastroenterology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
8 Department of Gastroenterology, Guangdong Second Provincial General Hospital, Guangzhou, China
9 Department of Gastroenterology, The Second Affiliated Hospital of Baotou Medical College, Baotou, China
10 Department of Gastroenterology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
11 Division of Gastroenterology and Hepatology, Digestive Disease Institute, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China

Correspondence Address:
Dr. Xiaolong Qi
No. 1, Donggang West Road, Chengguan District, Lanzhou City
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjg.sjg_22_21

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Background: Only a small proportion of patients with compensated advanced chronic liver disease (cACLD) had varices needing treatment (VNT) after recommended esophagogastroduodenoscopy (EGD) screening. We aimed to create a non-invasive nomogram based on routine tests to detect VNT in cACLD patients. Methods: The training cohort included 162 cACLD patients undergoing EGD in a university hospital, between January 2014 and September 2019. A nomogram was developed based on the independent predictors of VNT, selected using a multivariate logistic regression analysis. Thirty-three patients from eight university hospitals were prospectively enrolled as validation cohort between December 2018 and December 2019. Results: The prevalence of VNT was 32.7% (53/162) and 39.4% (13/33) in training and validation cohorts, respectively. The univariate analysis identified six risk factors for VNT. On the multivariate analysis, four of them, i.e., gallbladder wall thickness (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 0.98-1.56), spleen diameter (OR: 1.02; 95% CI: 1.00-1.04), platelet count (OR: 0.98; 95% CI: 0.97-0.99), and international normalized ratio (OR: 0.58; 95% CI: 0.06-5.84) were independently associated with VNT. Thus, a nomogram based on the four above - mentioned variables was developed, and showed a favorable performance for detecting VNT, with an area under receiver operating characteristic curve of 0.848 (95% CI: 0.769-0.927) in training cohort. By applying a cut-off value of 105 in validation cohort, 31.0% of EGD were safely spared with 3.4% of missed VNT. Conclusion: A nomogram based on routine clinical parameters was developed for detecting VNT and avoiding unnecessary EGD in cACLD patients.

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