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

Table 4 Summary of findings table for certainty of evidence by Grading of Recommendations, Assessment, Development and Evaluation approach for diagnostic accuracy of blood-based non-invasive tests as a predictor of varices in pediatric portal hypertension

Diagnostic test for the target condition	No. of studies (n = No. of participants)	Study design	Accuracy parameter	Risk of bias	Indirectness	Inconsistency	Imprecision	Publication bias	Overall certainty of evidence
APRI for EV	7 studies (n = 450)	Cross-sectional	Sensitivity	Serious1	Not serious	Serious2	Not serious	None	Low
			Specificity	Serious1	Not serious	Not serious	Not serious	None	Moderate
APRI for CSV	10 studies (n = 892)	Cross-sectional	Sensitivity	Serious1	Not serious	Not serious	Serious3	None	Low
			Specificity	Serious1	Not serious	Serious2	Not serious	None	Low
Platelet count for EV	5 studies (n = 368)	Cross-sectional	Sensitivity	Serious1	Not serious	Serious2	Not serious	None	Low
			Specificity	Serious1	Not serious	Serious2	Not serious	None	Low
Platelet count for CSV	7 studies (n = 612)	Cross-sectional	Sensitivity	Serious1	Not serious	Not serious	Not serious	None	Moderate
			Specificity	Serious1	Not serious	Serious2	Serious3	None	Very low
CPR for EV	4 studies (n = 320)	Cross-sectional	Sensitivity	Serious1	Not serious	Not serious	Not serious	None	Moderate
			Specificity	Serious1	Not serious	Not serious	Not serious	None	Moderate
CPR for CSV	8 studies (n = 624)	Cross-sectional	Sensitivity	Serious1	Not serious	Serious2	Serious3	None	Very low
			Specificity	Serious1	Not serious	Serious2	Not serious	None	Low
VPR for CSV	7 studies (n = 655)	Cross-sectional	Sensitivity	Serious1	Not serious	Not serious	Serious3	None	Low
			Specificity	Serious1	Not serious	Serious2	Not serious	None	Low
K-VaPS for CSV	5 studies (n = 315)	Cross-sectional	Sensitivity	Serious1	Not serious	Serious2	Not serious	None	Low
			Specificity	Serious1	Not serious	Not serious	Not serious	None	Moderate

¹As per the Quality Assessment of Diagnostic Accuracy Studies-2 tool, some of the included studies have high risk of bias across flow and timing domain.

²As there is substantial heterogeneity I² > 60%, we downgraded by one level, as we could not conduct meta-regression for all possible covariates.

³We downgraded by one level due to the wide confidence intervals around the accuracy parameters of some of the included studies.

EV: Esophageal/gastric varices; CSV: Clinically significant varices; APRI: Aspartate aminotransferase to platelet ratio index; CPR: Clinical prediction rule; VPR: Varices prediction rule; K-VaPS: King’s variceal prediction score.