A Noninvasive Model For The Diagnosis Of Esophagogastric Varices In Chronic Hepatitis B Patients With Concomitant Hepatocellular Carcinoma

Objective: To find a noninvasive model for prediction and evaluation of esophagogastric varices(EV)in chronic hepatitis B(CHB)patients with concomitant hepatocellular carcinoma(HCC).Methods: First-hospitalized CHB patients with suspect diagnosises of concomitant HCC were selected in our hospital,of whom routine ultrasound examination,shear wave mode(SWM)examination,gastroscopy and laboratory test results were collected.Laboratory test specimens were collected on the next morning after admission,ultrasound examination and gastroscopy were performed within 3 days.The objectives were divided into EV group,no EV group and high risk esophagogastric varices(HREV)group,no HREV group respectively.Univariate analysis and multivariate analysis were performed.Independent influencing factors of EV and HREV were used to construct a new diagnostic model,diagnosis performance of which was compared with some existing diagnosis models.Results: 111 patients were included in the final analysis,95 males and 16 females with a mean age of 53.1 +/-10.7 years.No EV in 78 cases,EV in 33 cases and HREV in 19 cases.EV group’s spleen index(SI),spleen vein diameter(SVD),spleen stiffness(SS)and γ-Glo were higher than those in no EV group,Alb and PLT were lower than those in no EV group.HREV group’s SI,SS,international normalized ratio(INR)and γ-Glo were higher than those in no HREV group.The differences were statistically significant(all p<0.05)and those indexes were selected as independent variables for the multivariate analysis of EV and HREV in CHB patients with concomitant HCC.As a result,SI,SS and γ-Glo were independent factors of both EV and HREV in CHB patients with concomitant HCC(all p<0.05),and were all risk factors(OR>1).A new EV and HREV prediction model: varices discriminate model(VDM)were constructed with these three indexes.The efficiency of VDM in the diagnosis of EV in CHB patients with concomitant HCC was good with an AUC value of 0.950(95%CI:0.906~0.993).Diagnostic sensitivity,specificity,PPV,NPV and coincidence rate were 90.9%,87.2%,87.7%,90.6% and 89.5% respectively with a cutoff value of 3.44.The efficiency of VDM in the diagnosis of EV in CHB patients with concomitant HCC was higher than all the existing diagnosis models.The efficiency of VDM in the diagnosis of HREV in CHB patients with concomitant HCC was good with an AUC value of 0.970(95%CI:0.942~0.997).Diagnostic sensitivity,specificity,PPV,NPV and coincidence rate were 100%,88%,89.3%,100% and 94% respectively with a cutoff value of 5.03.The efficiency of VDM in the diagnosis of HREV in CHB patients with concomitant HCC was higher than most existing diagnosis models.Conclusion: VDM has some value in predicting and evaluating EV in CHB patients with concomitant HCC but needs further validation.