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Liaoning Score for Prediction of Esophageal Varices in Cirrhotic Patients Who Had Never Undergone Endoscopy: A Multicenter Cross-Sectional Study in Liaoning Province, China

Advances in Therapy volume 36, pages 2167–2178 (2019)Cite this article

A Correction to this article was published on 24 June 2019

This article has been updated

Abstract

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.

Methods

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.

Results

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).

Conclusion

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.

Trial Registration

ClinicalTrials.gov Identifier: NCT02593799.

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Fig. 1

Change history

  • 24 June 2019

    Unfortunately, the fourteenth author’s name was incorrectly published in the Original Article. The correct author name is Cen Hong.

Abbreviations

AUC:

Area under curve

AUGIB:

Acute upper gastrointestinal bleeding

CI:

Confidence interval

EVs:

Esophageal varices

OR:

Odds ratio

PLT:

Platelets

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Acknowledgments

We thank the participants of the study.

Funding

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.

Authorship

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.

Authorship Contributions

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.

Disclosures

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.

Data Availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Author information

Author notes

    Authors and Affiliations

    1. Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command (Formerly General Hospital of Shenyang Military Area), Shenyang, Liaoning, China

      Xingshun Qi, Ran Wang, Han Deng, Cen Hong, Qianqian Li, Hongyu Li & Xiaozhong Guo

    2. Department of Gastroenterology, The First Hospital of China Medical University, Shenyang, Liaoning, China

      Yiling Li

    3. Department of Gastroenterology, Shengjing Hospital, China Medical University, Shenyang, Liaoning, China

      Lianjie Lin & Mengchun Wang

    4. Department of Gastroenterology, The First Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China

      Jing Li

    5. Department of Gastroenterology, Panjin Central Hospital, Panjin, Liaoning, China

      Lijun Wang

    6. The Sixth People’s Hospital of Shenyang, Shenyang, Liaoning, China

      Shuang Zheng

    7. Department of Gastroenterology, Dalian Friendship Hospital of Dalian Medical University, Dalian, Liaoning, China

      Yonghong Sun

    8. Department of Gastroenterology, General Hospital of Liaohe Oilfield Company, Panjin, Liaoning, China

      Lixin Zhao

    9. Department of Gastroenterology, Ansteel Group Hospital, Anshan, Liaoning, China

      Xiaolin Fu

    10. Department of Gastroenterology, General Hospital of Fuxin Mining Industry Group of Liaoning Health Industry Group, Fuxin, Liaoning, China

      Xinping Qiu

    Author notes

    1. The authors Xingshun Qi, Yiling Li and Ran Wang are co-first authors and contributed to this work equally.

      • To view enhanced digital features for this article go to https://doi.org/10.6084/m9.figshare.8005604.

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        Correspondence to Xingshun Qi or Xiaozhong Guo.

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        Qi, X., Li, Y., Wang, R. et al. Liaoning Score for Prediction of Esophageal Varices in Cirrhotic Patients Who Had Never Undergone Endoscopy: A Multicenter Cross-Sectional Study in Liaoning Province, China. Adv Ther 36, 2167–2178 (2019). https://doi.org/10.1007/s12325-019-00967-w

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        • DOI: https://doi.org/10.1007/s12325-019-00967-w

        Keywords

        • Endoscopy
        • Esophageal varices
        • Gastrointestinal bleeding
        • Liver cirrhosis
        • Portal hypertension