Liaoning Score for Prediction of Esophageal Varices in Cirrhotic Patients Who Had Never Undergone Endoscopy: A Multicenter Cross-Sectional Study in Liaoning Province, China
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Background and Aims
Endoscopy is necessary for assessment of esophageal varices (EVs) in cirrhotic patients, but its use is limited because of the poor compliance of patients and shortage of public health resources at primary hospitals or rural areas, especially in less well developed countries. A multicenter cross-sectional study aimed to establish a novel non-invasive score for prediction of EVs in cirrhotic patients who had never undergone endoscopy.
Patients with liver cirrhosis regardless of acute upper gastrointestinal bleeding (AUGIB) who underwent the first-time upper gastrointestinal endoscopy at 11 hospitals in Liaoning Province, China were considered. Independent predictors for EVs were identified by multivariate logistic regression analysis and then combined into an equation. The diagnostic performance with area under curve (AUC) was further evaluated by receiver operating characteristic curve analysis.
Overall, 363 patients were included, of whom 260 had EVs and 180 presented with AUGIB. In all patients, AUGIB, ascites, and platelets were the independent predictors for EVs. The equation (i.e., Liaoning score) was 0.466 + 1.088 × AUGIB (1 = yes; 0 = no) + 1.147 × ascites (1 = yes; 0 = no) − 0.012 × platelets, which had an AUC of 0.807 (p < 0.0001). In patients with AUGIB, ascites and platelets were the independent predictors for EVs. The equation was as follows: 1.205 + 1.557 × ascites (1 = yes; 0 = no) − 0.008 × platelets, which had an AUC of 0.782 (p < 0.0001). In patients without AUGIB, platelets was the only independent predictor for EVs, which had an AUC of 0.773 (p < 0.0001).
The Liaoning score is based on easy-to-access regular clinical and laboratory data and has a good diagnostic performance for non-invasive prediction of EVs in cirrhotic patients.
ClinicalTrials.gov Identifier: NCT02593799.
KeywordsEndoscopy Esophageal varices Gastrointestinal bleeding Liver cirrhosis Portal hypertension
Area under curve
Acute upper gastrointestinal bleeding
We thank the participants of the study.
This study was partially supported by the Grant from the Natural Science Foundation of Liaoning Province (no. 201800050) for Dr. Xingshun Qi. The article processing charges were funded by the authors.
All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.
Xingshun Qi conceived the study, analyzed the data, performed the statistical analyses, and wrote the paper; Yiling Li, Ran Wang, Lianjie Lin, Jing Li, Lijun Wang, Shuang Zheng, Yonghong Sun, Lixin Zhao, Xiaolin Fu, Mengchun Wang, Xinping Qiu, Han Deng, Cen Hong, Qianqian Li, and Hongyu Li collected the data and analyzed the data; Xiaozhong Guo conceived and supervised the study. All authors read and approved the final manuscript. The authors Xingshun Qi, Yiling Li and Ran Wang are co-first authors and contributed to this work equally.
All authors, including Xingshun Qi, Yiling Li, Ran Wang, Lianjie Lin, Jing Li, Lijun Wang, Shuang Zheng, Yonghong Sun, Lixin Zhao, Xiaolin Fu, Mengchun Wang, Xinping Qiu, Han Deng, Cen Hong, Qianqian Li, Hongyu Li, and Xiaozhong Guo, declared no conflict of interest related to this work. The funding sponsor did not influence the results of this study.
Compliance with Ethics Guidelines
This cross-sectional study was carried out following the rules of the Declaration of Helsinki and approved by the Medical Ethical Committee of the General Hospital of Northern Theater Command (formerly General Hospital of Shenyang Military Area), which is the principal affiliation of this study. The approval number was k(2015)11. This study was registered (ClinicalTrials.gov ID: NCT02593799). Considering the nature of this observational study, the patients’ written informed consent was waived.
The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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