CLINICAL TRIAL article
Front. Med.
Sec. Hepatobiliary Diseases
A novel dual elastography-based model for screening high-risk varices in hepatitis B virus-related cirrhosis
Xing Hu 1
Min Chen 2
Ying Zheng 1
Xiuhua Yang 3
Wei Zhang 3
Yao Zhang 4
Zhiyong Yin 4
Jintang Liao 5
Yangshuo Tang 5
Jie Yu 2
Ping Liang 2
Fankun Meng 1
1. Beijing Youan Hospital, Capital Medical University, Beijing, China
2. 5th Medical Center of Chinese PLA General Hospital, Beijing, China
3. First Affiliated Hospital of Harbin Medical University, Harbin, China
4. Capital Medical University Beijing Ditan Hospital, Beijing, China
5. Xiangya Hospital Central South University, Changsha, China
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Abstract
Background and objective: Variceal bleeding carries high mortality and recurrence rates, underscoring the urgent need for effective non-invasive tests (NITs) to assess the severity of esophageal varices (EVs) and predict bleeding risk. This study aimed to develop and validate a robust model for safely excluding high-risk varices (HRVs) in patients with hepatitis B virus (HBV)-related cirrhosis and to compare its diagnostic performance and clinical utility with established NITs. Methods: Consecutive patients with HBV-related cirrhosis were prospectively recruited from five centers and underwent dual elastography (dual-elasto) within one week of esophagogastroduodenoscopy (EGD). A training cohort from four centers was used to identify predictive variables for HRVs, which were analyzed using machine learning to develop the most reliable model. The final model was externally validated in an independent cohort from the fifth center. Diagnostic efficacy and clinical utility were compared across multiple NITs, including the Baveno VI criteria (B6C), expanded Baveno VI criteria (EB6C), platelet–spleen ratio (PSR), and RESIST-HCV criteria (RESIST). Results: Among 703 screened patients, 328 were enrolled (training cohort n = 184; validation cohort n = 144). Using logistic regression, we developed the DELU model incorporating six variables: platelet count (PLT), alanine aminotransferase (ALT), ascites, portal vein thrombosis (PVT), inverse difference moment (IDM), and liver stiffness (liver Vs). DELU achieved areas under the receiver operating characteristic curve (AUROCs) of 0.822 (training) and 0.779 (validation), outperforming RESIST (0.600 and 0.626) and B6C (0.569 and 0.575). EB6C and PSR were excluded because they exceeded the 5% missed-HRV threshold. DELU demonstrated the highest spared-EGD rates (20.7% training; 11.1% validation) and maintained robust performance across subgroups, including Child-Pugh B/C (AUROC 80.3%), Child-Pugh A (79.7%), antiviral therapy (ART)-treated (82.5%), and virologically suppressed patients (84.6%). Performance was not influenced by hepatocellular carcinoma (HCC) status, sex, or body mass index (BMI).
Summary
Keywords
cirrhosis, dual elastography, Hepatitis B, high-risk varices, Non-invasive test
Received
18 September 2025
Accepted
20 January 2026
Copyright
© 2026 Hu, Chen, Zheng, Yang, Zhang, Zhang, Yin, Liao, Tang, Yu, Liang and Meng. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jie Yu; Ping Liang; Fankun Meng
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