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Validation of a multivariate model predicting presence and size of varices
James R Burton1, Suthat Liangpunsakul, Jodi Lapidus
1Division of Gastroenterology and Hepatology, University of Colorado Health Sciences University, Denver, CO 80262, USA. James.Burton@UCHSC.edu
Insights
This study validates that low platelet counts and advanced Child-Pugh class (CPC) predict large esophageal varices in cirrhosis patients. The findings support using these markers to assess varices risk.
Area of Science:
- Hepatology
- Gastroenterology
- Clinical Medicine
Background:
- A prior model indicated low platelets and advanced Child-Pugh class (CPC) correlate with large esophageal varices.
- Esophageal varices are a significant complication of cirrhosis.
Purpose of the Study:
- To validate specific platelet count cut-offs for predicting large varices in Child-Pugh class A (CPC-A) patients and any varices in CPC-B/C patients.
- To confirm the predictive accuracy of low platelets and advanced CPC for esophageal varices.
Main Methods:
- Validation of a predictive model using three independent cohorts of cirrhosis patients undergoing screening for esophageal varices.
- Statistical analysis included sensitivity, specificity, predictive values, likelihood ratios, and c-statistic to assess prediction accuracy.
Main Results:
- Combined analysis of original and validation cohorts confirmed a negative predictive value of 92.1% for platelets ≤80,000/microL in CPC-A for large varices.
- A positive predictive value of 80.1% was observed for platelets ≤90,000/microL in CPC-B/C for any varices.
- The overall c-statistic for the combined cohorts was 0.67, indicating moderate predictive ability. Other factors like splenomegaly and MELD score were not significant predictors.
Conclusions:
- The study validates the predictive model for esophageal varices using low platelet counts and advanced Child-Pugh class.
- No additional significant risk factors were identified despite combining multiple cohorts.
Background:
A model developed by our group identified low platelets and advanced Child-Pugh class (CPC) as being associated with large varices.
Goals:
To validate a defined cut-off of platelets < or =80,000/microL in CPC-A for large varices and platelets < or =90,000/microL in CPC-B/C for any varices.
Study:
Validation cohorts consisted of patients with cirrhosis undergoing screening for varices from Oregon Health and Science University (n=152), Indiana University (n=252), and Genoa, Italy (n=101). Similar clinical and laboratory data were collected as for the original cohort. To assess the ability of these cut-offs to predict presence of large and any varices, sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the c-statistic were measured.
Results:
The validation cohorts were statistically different from the original cohort with regards to CPC and prevalence of large varices. Combining the original (n=301) and validation cohorts resulted in a negative predictive value of 92.1% for platelets < or =80,000/microL in CPC-A for large varices and positive predictive value of 80.1% for platelets < or =90,000/microL in CPC-B/C for any varices. Combining the 4 cohorts yielded a c-statistic of 0.67 (95% confidence interval: 063-0.72). No other factors such as splenomegaly and Model for End-Stage Liver Disease score were identified as significant.
Conclusions:
This study confirms the validity of a previous model identifying low platelets and advanced CPC class as predictors of large varices. Despite combining the cohorts, no other risk factors were identified.
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