{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T05:04:06Z","timestamp":1789707846648,"version":"4.0.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Gastroesophageal varices (GOV) and variceal hemorrhage are major life-threatening complications of cirrhosis. Although esophagogastroduodenoscopy (EGD) remains the diagnostic gold standard, its invasiveness, cost, and limited patient adherence underscore the need for reliable non-invasive risk-stratification tools. We aimed to identify independent predictors of high-risk esophageal varices (HREV) and develop and validate a simple, cost-effective nomogram integrating routinely available clinical and ultrasonographic parameters.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective cohort study, we enrolled 575 cirrhotic patients hospitalized between January 2010 and December 2019. All participants underwent contemporaneous EGD and abdominal color Doppler ultrasonography during the same hospitalization. A nomogram was constructed based on independent predictors identified by multivariate analysis. Model performance was evaluated using the area under the receiver operating characteristic curve (AUROC), calibration curves, decision-curve analysis (DCA), and compared with established non-invasive scores (APRI, AAR, FIB-4, PC\/SD) and with each individual predictor; the training-derived threshold was fixed and applied unchanged to the validation cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Endoscopy identified HREV in 71.8% (413\/575) of patients. Multivariate analysis revealed six independent predictors: male sex, hemoglobin (HGB), platelet count (PLT), right liver thickness (RLT), portal vein diameter (PVD), and spleen diameter (SD). The developed nomogram demonstrated satisfactory discrimination, with AUROCs of 0.803 (95% CI: 0.755\u20130.850) in the training cohort and 0.807 (95% CI: 0.734\u20130.880) in the validation cohort, outperforming the biochemical scores APRI and AAR, and significantly improving risk reclassification over both FIB-4 and the platelet count-to-spleen diameter (PC\/SD) ratio (NRI and IDI, all\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&amp;lt;\u20090.05). It also outperformed each single component in the training cohort (spleen diameter alone, 0.742;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.003) but not in validation (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.061); at the fixed threshold of 0.770 the negative predictive value was 48.2%. Calibration and DCA confirmed satisfactory predictive accuracy and clinical utility.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A simple nomogram based on routine clinical and ultrasonographic variables stratified HREV risk and outperformed established biochemical scores. Its negative predictive value in this high-prevalence cohort was insufficient to defer endoscopy safely; the nomogram is therefore proposed for prioritising endoscopy where transient elastography is unavailable, rather than as a substitute for Baveno-based rule-out strategies. External validation in lower-prevalence populations is required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1946799","type":"journal-article","created":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T04:33:33Z","timestamp":1789706013000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A non-invasive nomogram for high-risk esophageal varices in cirrhosis without transient elastography: development and internal validation"],"prefix":"10.3389","volume":"13","author":[{"given":"Yi","family":"Wu","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Infectious Diseases, Zhaoqing Hospital, The Third Affiliated Hospital of Sun Yat-sen University","place":["Zhaoqing, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junyang","family":"Luo","sequence":"additional","affiliation":[{"name":"Department of Interventional Radiology, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuixian","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuaishuai","family":"Kong","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dandan","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenhui","family":"Guo","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nianfeng","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Information Technology, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhebin","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurong","family":"Gu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhaoxia","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiliang","family":"Gao","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Infectious Diseases, Zhaoqing Hospital, The Third Affiliated Hospital of Sun Yat-sen University","place":["Zhaoqing, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, The Third Affiliated Hospital of Sun Yat-sen University","place":["Guangzhou, Guangdong, China"]},{"name":"Department of Infectious Diseases, Zhaoqing Hospital, The Third Affiliated Hospital of Sun Yat-sen University","place":["Zhaoqing, Guangdong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S2468-1253(19)30349-8","article-title":"The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990\u20132017: a systematic analysis for the global burden of disease study 2017","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol 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