Data Sheet 1_A non-invasive nomogram for high-risk esophageal varices in cirrhosis without transient elastography: development and internal validation.docx

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: 0.755–0.850) in the training cohort and 0.807 (95% CI: 0.734–0.880) 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 P < 0.05).

It also outperformed each single component in the training cohort (spleen diameter alone, 0.742; P = 0.003) but not in validation (P = 0.061); at the fixed threshold of 0.770 the negative predictive value was 48.2%. Calibration and DCA confirmed satisfactory predictive accuracy and clinical utility.</p>Conclusions<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.</p>