Diagnostic accuracy of blood-based non-invasive tests for prediction of varices in pediatric portal-hypertension: A systematic review and meta-analysis

Table 1 Characteristics of included studies evaluating the diagnostic performance of aminotransferase-to-platelet ratio index and platelet count for prediction of oesophageal/gastric varices in pediatric portal hypertension, mean ± SD/median (25^th-75^th percentiles)/n (%)

Index test	Ref.	Study design/period	Sample size/gender	Age	Etiology of portal hypertension	Prevalence of varices	Interval between index test and reference standard	Any grade oesophageal/gastric varices						Clinically significant varices
								Cut-off value	TP	FP	FN	TN	AUROC	Cut-off value	TP	FP	FN	TN	AUROC
APRI	Colecchia et al[29], Italy, 2011	Prospective single-center (1990-2009)	31. Male = 13 (43)	12 ± 15.5 years	Cirrhotic. Biliary atresia-post KPE	48.3%	1 day	> 0.96	13	3	2	13	0.88
	Chongsrisawat et al[30], Thailand, 2011	Prospective single-center	73. Gender = NA	9.11 ± 5.64 years	Cirrhotic. Biliary atresia-post KPE	53.4%	NA	> 1.92	33	6	6	28	0.87
	Adami et al[34], Brazil, 2013	Retrospective single-center (2000-2011)	103. Male = 47 (45.7)	8.9 ± 4.7 years	Cirrhotic + non-cirrhotic	68.9%	Up to 3 months	> 1.4	45	11	26	21
	Isted et al[35], United Kingdom, 2015	Retrospective single-center (2004-2012)	195. Male = 83 (42.5)	55 (11-216) days	Cirrhotic. Biliary atresia post-KPE	21.5%	NA							≥ 1.64	29	57	13	96	0.72
	Voutilainen et al[36], Finland, 2016	Prospective single-center (2012-2015)	64. Male = 34 (53.1)	5.2 (2.1-13.9) years	Cirrhotic. Biliary atresia-post KPE (34.3%). IFALD (42.1%). Cholestatic liver disease (9.3%). Miscellaneous (14.3%)	21.8%	1 day	> 0.6	14	17	0	33	0.832
	Tomita et al[37], Japan, 2016	Prospective single-center (2011-2014)	16. Gender = NA	6.3 (0.7-33.5) years	Cirrhotic. Biliary atresia-post KPE	18.7%	Up to 3 months							> 4.87	2	0	1	13	0.72
	Witters et al[38], United Kingdom, 2017	Prospective single-center (2005-2014)	124. Male = 66 (53.2)	8.81 ± 5.60 years	Cirrhotic + non-cirrhotic	63.7%	Up to 6 months							> 1.603	48	20	31	25	0.61
	Adami et al[39], Brazil, 2018	Retrospective single-center (2000-2011)	98. Male = 46 (46.9)	9.1 ± 4.7 years	Cirrhotic. Autoimmune hepatitis (21.4%). Biliary atresia (26.5%). Sclerosing cholangitis (6.1%). Cystic fibrosis (6.1%). Idiopathic biliary cirrhosis (12.2%). Miscellaneous (27.5%)	32.6%	Up to 3 months							> 1.4	18	35	14	31
	Yoon et al[41], South Korea, 2019	Retrospective single-center (2015-2016)	22. Male = 10 (45.4)	10 (4-18) years	Cirrhotic. Biliary atresia-post KPE	27.2%	Up to 6 months	> 0.65	6	4	0	12	0.844
	Chiou et al[42], Singapore, 2019	Retrospective single-center (1989-2016)	72. Male = 35 (48.6)	NA	Cirrhotic. Biliary atresia-post KPE	22.2%	6 months							≥ 3	13	13	3	43	0.828
	Yokoyama et al[43], Japan, 2019	Prospective single-center (2018-2019)	34. Male = 11 (32.2)	5.2 ± 5.92 years	Cirrhotic. Biliary atresia-post KPE	41.1%	1-2 days							≥ 1.63	10	3	4	17	0.750
	Lampela et al[44], Finland, 2020	Prospective single-center (1989-2017)	45. Gender = NA	1.6 (0.7-14) years	Cirrhotic. Biliary atresia-post KPE	46.6%	None. Both done on same day							≥ 1.01	19	12	2	12	0.64
	Kumar et al[46], India, 2020	Prospective single-center (2018-2019)	59. Gender = NA	NA	Cirrhotic. Wilson disease (25%). Autoimmune hepatitis (16%). Biliary atresia (11%). Cholestatic liver disease (8%). Miscellaneous (40%)	54.2%	Up to 1 week	≥ 1.5	26	7	6	20	0.81
	Lopes et al[48], Brazil, 2021	Retrospective single-center (2004-2018)	158. Male = 70 (44.3)	5.38 (2.08-11.52) years	Cirrhotic. Biliary atresia (35.4%). Autoimmune hepatitis (27.8%). Sclerosing cholangitis (14.5%). Alpha1-antitrypsin deficiency (8.2%). Cryptogenic cirrhosis (6.3%). Miscellaneous (7.5%)	18.9%	Up to 3 months							≥ 1.4	26	63	4	65	0.744
	Rahmani et al[49], Iran, 2021	Prospective single-center	98. Male = 66 (67.3)	9.48± 4.9 years	Cirrhotic	43.8%	NA	≥ 0.45	33	18	10	37	0.799
	Poddar et al[16], India, 2023	Retrospective single-center (2010-2022)	110. Male = 75 (68.1)	12 (8-24) months	Cirrhotic. Biliary atresia	31.8%	None							≥ 2	29	28	6	47	0.720
	Yokoyama et al[50], Japan, 2024	Prospective single-center (2018-2022)	53. Male = 17	4 (0-18) years	Cirrhotic. Biliary atresia-post KPE	52.8%	Up to 1 month							≥ 1.476	22	5	6	20	0.826
Platelet count	Gana et al[32], Multicentric, 2011	Prospective multi-center (2007-2010)	108. Male = 53 (48)	11 ± 5.4 years	Cirrhotic + non-cirrhotic	68.5%	Up to 3 weeks	< 1.15 lakh/mm3	60	10	14	24	0.790
	Alcantara et al[33], Brazil, 2012	Prospective. Single-center (2007-2011)	35. Gender = NA	Median: 11 years	Cirrhotic. Autoimmune hepatitis (54.2%). Biliary atresia (28.5%). Miscellaneous (17.1%)	48.5%	Up to 3 months	< 1.19 lakh/mm3	13	3	4	15	0.830
	Adami et al[34], Brazil, 2013	Retrospective single-center (2000-2011)	103. Male = 47 (45.7)	8.9 ± 4.7 years	Cirrhotic + non-cirrhotic	68.9%	Up to 3 months	< 1.15 lakh/mm3	48	6	23	26	0.820
	Adami et al[39], Brazil, 2018	Retrospective single-center (2000-2011)	98. Male = 46 (46.9)	9.1 ± 4.7 years	Cirrhotic	32.6%	Up to 3 months							< 115 × 109/L	21	30	11	36	0.67
	Chiou et al[42], Singapore, 2019	Retrospective single-center (1989-2016)	72. Male = 35 (48.6)	NA	Cirrhotic. Biliary atresia post-KPE	22.2%	6 months							< 100 × 109/L	12	11	4	45	0.800
	Alam et al[45], Bangladesh, 2019	Prospective single-center (2016-2018)	84. Male = 44 (52.4)	9.7 ± 3.2 years	Cirrhotic. Wilson disease (65.4%). Hepatitis B/C (7.1%). Autoimmune hepatitis (7.1%). Biliary atresia (5.9%). Miscellaneous (14.2%)	71.4%-EV. 55%-CSV	None	< 1 lakh/mm3	26	1	34	23	0.740	< 100 × 109/L	17	9	16	18	0.640
	Vadlapudi et al[47], India, 2020	Prospective single-center (2017-2018)	55. Male = 33 (60)	9.37 ± 3.12 years	Non-cirrhotic Extrahepatic portal vein thrombosis	87.2%	NA							< 117 × 109/L	37	3	11	4	0.568
	Lopes et al[48], Brazil, 2021	Retrospective single-center (2004-2018)	158. Male = 70 (44.3)	5.38 (2.08-11.52) years	Cirrhotic	18.9%	Up to 3 months							< 100 × 109/L	13	21	17	107	0.709
	Rahmani et al[49], Iran, 2021	Prospective single-center	98. Male = 66 (67.3)	9.48 ± 4.9 years	Cirrhotic	43.8%	NA	< 1.1 lakh/mm3	36	18	7	37	0.833
	Poddar et al[16], India, 2023	Retrospective single-center (2010-2022)	110. Male = 75 (68.1)	12 (8–24) months	Cirrhotic. Biliary atresia	31.8%	None							< 150 × 109/L	26	25	9	50	0.690
	Yokoyama et al[50], Japan, 2024	Prospective single-center (2018-2022)	53. Male = 17	4 (0-18) years	Cirrhotic. Biliary atresia post-KPE	52.8%	Up to 1 month							< 141 × 109/L	20	10	8	15	0.721

APRI: Aspartate aminotransferase to platelet ratio index; EV: Esophageal/gastric varices; KPE: Kasai portoenterostomy; CSV: Clinically significant varices; TP: True positive; FP: False positive; TN: True negative; FN: False negative; AUROC: Area under receiver operating characteristic curve; NA: Not available.