Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 7, 2020; 26(45): 7204-7221
Published online Dec 7, 2020. doi: 10.3748/wjg.v26.i45.7204
Liver fibrosis index-based nomograms for identifying esophageal varices in patients with chronic hepatitis B related cirrhosis
Shi-Hao Xu, Fang Wu, Le-Hang Guo, Wei-Bing Zhang, Hui-Xiong Xu
Shi-Hao Xu, Le-Hang Guo, Wei-Bing Zhang, Hui-Xiong Xu, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Nanjing Medical University, Shanghai 200072, China
Shi-Hao Xu, Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Fang Wu, Department of Gastroenterology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
Author contributions: Xu SH and Wu F carried out the ultrasonography and endoscopy in the study, performed the data collection, and drafted the manuscript; Guo LH and Zhang WB helped to draft the manuscript and performed the statistical analysis; Xu HX conceived the study, participated in its coordination, and gave final approval of the version to be published; all authors read and approved the final manuscript.
Supported by The Natural Science Foundation of Zhejiang Province, China, No. LY18H030011.
Institutional review board statement: The study was reviewed and approved (approval No. 2016-184) by the Ethics Committee of The First Affiliated Hospital of Wenzhou Medical University.
Informed consent statement: Informed written consent was obtained from the patients prior to the study.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hui-Xiong Xu, PhD, Chief Physician, Professor, Department of Medical Ultrasound, Shanghai Tenth People’s Hospital of Nanjing Medical University, No. 301 Yanchang Middle Road, Jing’an District, Shanghai 200072, China. xuhuixiong@126.com
Received: September 2, 2020
Peer-review started: September 2, 2020
First decision: September 30, 2020
Revised: October 7, 2020
Accepted: November 2, 2020
Article in press: November 2, 2020
Published online: December 7, 2020
ARTICLE HIGHLIGHTS
Research background

Esophageal varices (EV) are an important cause of mortality for patients with chronic hepatitis B (CHB) related cirrhosis.

Research motivation

There is no reliable and non-invasive tool to monitor EV, predict the clinical outcome, and adjust the follow-up strategy.

Research objectives

This study aimed to develop nomogram models including non-invasive and clinically accessible indicators to assess the risk and severity of EV.

Research methods

Patients with CHB related cirrhosis were retrospectively included and divided into a training or validation cohort. Ultrasound parameters and blood indexes were applied to construct the nomograms, which were subsequently evaluated by receiver operating characteristic, concordance index, and decision curve analyses, and tested in the validation cohort.

Research results

The novel nomograms composed of clinical and ultrasonic variables were constructed and proved better than liver fibrosis index, splenic portal index, ratio of platelet count to spleen diameter, King’s score, and Lok index for predicting the risk and severity of EV.

Research conclusions

The established novel nomograms are reliable and convenient for clinicians to predict EV in a non-invasive way and make preventive and therapeutic measurements.

Research perspectives

The novel models need to be tested by multi-center prospective studies and adjusted for particular groups, such as patients complicated with other liver diseases.