Development of a noninvasive ultrasound-based model for predicting high-risk esophageal varices in hepatitis-related cirrhosis.

PURPOSE: High-risk esophageal varices (HREVs) are a serious complication of cirrhosis, and reliable noninvasive tools are needed to improve endoscopic triage. This study aimed to develop and validate an ultrasound-based model for predicting HREVs in patients with hepatitis-related cirrhosis. METHODS: This retrospective study included 293 patients who underwent endoscopy and noninvasive assessment between January 2019 and January 2023. Patients were assigned to training (n=210) and validation cohorts (n=83). Predictors were selected using univariable analysis, multivariable logistic regression, and Akaike information criterion-based backward selection. Discrimination, calibration, and clinical utility were evaluated using receiver operating characteristic analysis, calibration curves, decision curve analysis, and clinical impact curves. RESULTS: Portal vein velocity (PVV) and spleen volume (SV) were retained in the final model. The model incorporated PVV as a linear term and SV as a restricted cubic spline term. The area under the receiver operating characteristic curve was 0.951 in the training cohort and 0.956 in the validation cohort. At a cutoff of 0.30, the model showed high diagnostic performance and outperformed the single predictors and the Baveno VI criteria. Calibration and decision curve analyses indicated good agreement and favorable clinical utility. CONCLUSION: This model provides a simple, noninvasive approach to individualized prediction of HREVs in patients with hepatitis-related cirrhosis.