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

Table 2 Characteristics of included studies evaluating the diagnostic performance of various non-invasive blood-test-based indices for the 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	Prevalence of varices	Etiology of portal hypertension	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
Clinical prediction rule	Gana et al[31], Canada, 2010	Retrospective single-center (2000-2007)	51. Male= 25 (49)	Mean (range): 11 (0.2-17) years	33.3%	Cirrhotic + non-cirrhotic	Up to 6 months	≤ 116	14	4	3	30	0.93
	Gana et al[32], Multicentric, 2011	Prospective multi-center (2007-2010)	108. Male = 53 (48)	11 ± 5.4 years	68.5%	Cirrhotic + non-cirrhotic	Up to 3 weeks	≤ 116	60	9	14	25	0.80
	Adami et al[34], Brazil, 2013	Retrospective single-center (2000-2011)	103. Male = 47 (45.7)	8.9 ± 4.7 years	68.9%	Cirrhotic + non-cirrhotic	Up to 3 months	≤ 114	53	7	18	25	0.77
	Isted et al[35], United Kingdom, 2015	Retrospective single-center (2004-2012)	195. Male = 83 (42.5)	55 (11-216) days	21.5%	Cirrhotic. Biliary atresia post-KPE	NA							≤ 114	29	55	13	98	0.74
	Tomita et al[37], Japan, 2016	Prospective single-center (2011-2014)	16	Median (range): 6.3 (0.7-33.5) years	18.7%	Cirrhotic. Biliary atresia-post KPE	Up to 3 months							≤ 106	2	2	1	11	0.76
	Witters et al[38], United Kingdom, 2017	Prospective single-center (2005-2014)	124. Male = 66 (53.2)	8.81 ± 5.60 years	63.7%	Cirrhotic + non-cirrhotic	Up to 6 months							≤ 114	60	18	19	27	0.73
	Adami et al[39], Brazil, 2018	Retrospective single-center (2000-2011)	98. Male= 46 (46.9)	9.1 ± 4.7 years	32.6%	Cirrhotic	Up to 3 months							≤ 114	26	31	6	35	0.65
	Sutton et al[40], United Kingdom, 2018	Prospective single-center (2015-2016)	67. Male= 32 (47.7)	8.5 (0.3-18) years	56.7%	Cirrhotic + non-cirrhotic	None							≤ 106.3	17	10	21	19	0.54
	Yokoyama et al[43], Japan, 2019	Prospective single-center (2018-2019)	34. Male= 11 (32.2)	5.2 ± 5.92 years	41.1%	Cirrhotic. Biliary atresia-post KPE	1-2 days							≤ 120.3	12	7	2	13	0.782
	Lampela et al[44], Finland, 2020	Prospective single-center (1989-2017)	45. Gender = NA	1.6 (0.7-14) years	46.6%	Cirrhotic. Biliary atresia-post KPE	None. Both done on same day							≤ 105	11	4	10	20	0.69
	Diéguez Hernández-Vaquero et al[51], Spain, 2024	Retrospective single-center	45 UGIE (in 18 patients). Male = 11 (61.1)1	NA	80%	Non-cirrhotic. Extrahepatic portal vein thrombosis	Up to 6 months							≤ 115	8	0	28	9	0.815
	Jezequel et al[52], France, 2025	Retrospective single-center (2020-2024)	58. Male = 28 (48.3)	9.20 (4.0-14.3) years	53.4%	Cirrhotic + non-cirrhotic. Biliary atresia (32.8%). Autoimmune hepatitis (19%). Portal vein thrombosis (13.8%). Wilson disease (5.2%). Miscellaneous (29.2%)	NA	≤ 116.4	23	6	8	21	0.71
Varice prediction rule	Isted et al[35], United Kingdom, 2015	Retrospective single-center (2004-2012)	195. Male = 83 (42.5)	55 (11-216) days	21.5%	Cirrhotic. Biliary atresia post-KPE	NA							≤ 7.2	36	44	6	109	0.75
	Tomita et al[37], Japan, 2016	Prospective single-center (2011-2014)	16. Gender = NA	Median (range): 6.3 (0.7-33.5) years	18.7%	Cirrhotic. Biliary atresia post-KPE	Up to 3 months							≤ 7.16	3	3	0	10	0.85
	Witters et al[38], United Kingdom, 2017	Prospective single-center (2005-2014)	124. Male = 66 (53.2)	8.81 ± 5.60 years	63.7%	Cirrhotic. Biliary atresia post-KPE	Up to 6 months							≤ 3.63	63	18	16	27	0.72
	Chiou et al[42], Singapore, 2019	Retrospective single-center (1989-2016)	72. Male = 35 (48.6)	NA	22.2%	Cirrhotic. Biliary atresia post-KPE	6 months							≤ 3	13	8	3	48	0.833
	Lampela et al[44], Finland, 2020	Prospective single-center (1989-2017)	45. Gender = NA	1.6 (0.7-14) years	46.6%	Cirrhotic. Biliary atresia post-KPE	None. Both done on same day							≤ 2.76	16	10	5	14	0.720
	Lopes et al[48], Brazil, 2021	Retrospective single-center (2004-2018)	158. Male = 70 (44.3)	5.38 (2.08-11.52) years	18.9%	Cirrhotic	Up to 3 months							≤ 7.2	25	66	5	62	0.752
	Diéguez Hernández-Vaquero et al[51], Spain, 2024	Retrospective single-center	45 UGI. (in 18 patients). Male = 11 (61.1)	NA	80%	Non-cirrhotic. Extrahepatic portal vein thrombosis	Up to 6 months							≤ 7.3	24	0	12	9	0.858
King’s variceal prediction score (K-VaPS)	Witters et al[38], United Kingdom, 2017	Prospective single-center (2005-2014)	124. Male = 66 (53.2)	8.81 ± 5.60 years	63.7%	Cirrhotic + non-cirrhotic	Up to 6 months							≤ 76	57	12	22	33	0.77
	Sutton et al[40], United Kingdom, 2018	Prospective single-center (2015-2016)	67. Male = 32 (47.7)	Median (range): 8.5 (0.3-18) years	56.7%	Cirrhotic + non-cirrhotic	None							≤ 75.2	15	11	23	18	0.48
	Yokoyama et al[43], Japan, 2019	Prospective single-center (2018-2019)	34. Male = 11 (32.2)	5.2 ± 5.92 years	41.1%	Cirrhotic. Biliary atresia-post KPE	1-2 days							≤ 96.1	10	5	4	15	0.775
	Lampela et al[44], Finland, 2020	Prospective single-center (1989-2017)	45. Gender = NA	1.6 (0.7-14) years	46.6%	Cirrhotic. Biliary atresia-post KPE	None. Both done on same day							≤ 68	14	8	7	16	0.670
	Diéguez Hernández-Vaquero et al[51], Spain, 2024	Retrospective single-center	45 UGIE (in 18 patients). Male = 11 (61.1)1	NA	80%	Non-cirrhotic. Extrahepatic portal vein thrombosis	Up to 6 months							≤ 76	2	0	34	9	0.753

¹In this study, total number of upper gastrointestinal endoscopy was used for the calculation of diagnostic accuracy instead of the number of patients.

KPE: Kasai portoenterostomy; TP: True positive; FP: False positive; TN: True negative; FN: False negative; AUROC: Area under receiver operating characteristic curve; NA: Not available; UGIE: Upper gastrointestinal endoscopy.