Evaluation of the VITRO Score as a Non-Invasive Marker for Esophageal Varices in Liver Cirrhosis

Evaluation of the VITRO Score as a Non-Invasive Marker for Esophageal Varices in Liver Cirrhosis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evaluation of the VITRO Score as a Non-Invasive Marker for Esophageal Varices in Liver Cirrhosis Hala Saleh Muhammad, Khaled El Karmoty, Hesham Hamdy, Salah Shaarawy This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7124577/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Bleeding from esophageal varices is a leading cause of mortality in patients with liver cirrhosis. These varices reflect the presence of clinically significant portal hypertension (CSPH), defined as a portal pressure gradient exceeding 10 mmHg. Currently, the gold standard diagnostic tools—hepatic venous pressure gradient (HVPG) measurement and upper gastrointestinal endoscopy (UGIE)—are invasive, costly, and not routinely accessible. Aim To evaluate the VITRO score (von Willebrand factor antigen/platelet count ratio) as a non-invasive marker for the presence of esophageal varices in patients with CSPH. Patients and Methods: Sixty Egyptian cirrhotic patients were recruited and classified into two groups—those with and without esophageal varices—based on UGIE findings. All participants underwent comprehensive clinical evaluation, hematological and biochemical laboratory testing, and serum von Willebrand factor antigen (VWF) quantification. Results The VITRO score was significantly higher in patients with esophageal varices (median 1.22, IQR: 1.03–1.32) compared to those without (median 0.23, IQR: 0.15–0.40), ( p < 0.001). VITRO values ranged from 0.78 to 1.92 in the varices group, and from 0.08 to 0.82 in the non-varices group. No significant correlations were observed between the VITRO score and age, WBC count, hemoglobin, renal function, electrolytes, liver enzymes, AFP, or MELD score. ROC analysis revealed a cutoff value of > 0.82 with a sensitivity of 93.75% and specificity of 100% for detecting esophageal varices. Conclusion The VITRO score is a promising non-invasive biomarker for identifying esophageal varices in patients with clinically significant portal hypertension, offering potential to reduce reliance on invasive procedures. VITRO Score von Willebrand Factor Thrombocyte Ratio Esophageal Varices Portal Hypertension Liver Cirrhosis Figures Figure 1 Introduction Cirrhosis is characterized by the histological presence of regenerative nodules surrounded by fibrous bands, resulting from chronic liver injury. This architectural distortion leads to increased intrahepatic resistance, impaired hepatocellular function, and a heightened risk of hepatocellular carcinoma (HCC) (1 ). A major consequence of cirrhosis is portal hypertension, defined by a portal pressure gradient exceeding 5 mmHg. Clinically significant portal hypertension (CSPH) is established when this gradient surpasses 10 mmHg, prompting the development of portosystemic collaterals such as gastroesophageal varices and elevating the risk of decompensation events including ascites, variceal bleeding, and hepatic encephalopathy ( 2 ) ( 3). Thrombocytopenia, often the earliest hematological abnormality in chronic liver disease, is commonly attributed to splenic sequestration in the setting of portal hypertension. Additional factors—such as reduced thrombopoietin (TPO) levels associated with progressive fibrosis, alcohol-related marrow suppression, viral hepatitis, autoimmune destruction, and sepsis—also contribute to diminished platelet counts (< 150,000/µL) ( 4 ). Von Willebrand factor antigen (vWF-Ag), released by activated endothelial cells, serves as a marker of endothelial dysfunction. Its levels are elevated in cirrhotic patients, reflecting both the severity of fibrosis and portal hypertension. vWF concentrations also correlate with the degree of endotoxemia—attributable to intestinal dysbiosis, impaired hepatic clearance, and microbial translocation to mesenteric lymph nodes ( 5 ) ( 6). Given that both thrombocytopenia and vWF-Ag are associated with the presence and severity of CSPH, they can be jointly applied through the VITRO score. This score has shown promise as a non-invasive diagnostic tool for portal hypertension and esophageal varices. Based on existing evidence ( 7 ), we hypothesize that the VITRO score may offer enhanced diagnostic accuracy in detecting CSPH. AIM OF THE WORK To evaluate the vitro score as a non-invasive marker for presence of esophageal varices in clinically significant portal hypertension. Patients and Methods This comparative cross-sectional study was conducted at the Internal Medicine and Hepatology outpatient clinics and inpatient wards of Ain Shams University Hospitals between January and June 2023. The study included 60 Egyptian patients aged 37–80 years with sonographically confirmed liver cirrhosis, recruited after obtaining written informed consent. Patients were categorized into two groups based on the presence or absence of esophageal varices, as assessed by upper gastrointestinal endoscopy (UGIE). Inclusion Criteria : Adults (> 18 years) with liver cirrhosis confirmed by pelvi-abdominal ultrasound. Exclusion Criteria : Patients ≤ 18 years, those presenting with hematemesis and/or melena, and individuals with ultrasound findings indicative of portal vein thrombosis, veno-occlusive disease, hepatic focal lesions suggestive of hepatocellular carcinoma, or bilharzial/periportal fibrosis. Methodology : All enrolled patients underwent: Comprehensive History Taking: Including past medical history of liver disease, signs of hepatic decompensation (ascites, encephalopathy, bleeding episodes), extrahepatic manifestations, and systemic symptoms. Physical Examination: General and focused evaluation for stigmata of chronic liver disease. Laboratory Investigations: Complete blood count (CBC) Liver function tests: AST, ALT, total and direct bilirubin, serum albumin Coagulation profile: PT, PTT, INR Renal function: BUN, serum creatinine, sodium, potassium Viral markers: HCV antibody, HBsAg Tumor marker: alpha-fetoprotein (AFP) Von Willebrand Factor Antigen (vWF-Ag) Radiological Assessment and Endoscopy Abdominal Ultrasound: Performed after a 7-hour fast in the supine position. Parameters evaluated included liver size, echogenicity (bright/coarse), splenic bipolar diameter, portal vein diameter, and any hepatic focal lesions. Upper Gastrointestinal Endoscopy: Used to determine presence and grade of esophageal varices. vWF-Ag Assay Protocol The vWF antigen was measured using a quantitative Enzyme-Linked Immunosorbent Assay (ELISA) kit. Briefly: Microplate wells were pre-coated with human vWF Ag antibody. Samples were added, followed by biotinylated anti-vWF antibody and Streptavidin-HRP. After incubation and washing, substrate was added, and the reaction was terminated with acid stop solution. Absorbance was measured at 450 nm. Results were calculated using a standard curve generated via regression analysis using OD values plotted against known concentrations. Statistical Analysis Data were analyzed using SPSS version 10.0 (Windows). Microsoft PowerPoint was used for chart generation. Quantitative Variables: Presented as mean ± SD. Comparisons between two groups were made using Student’s t-test; for three-group comparisons, one-way ANOVA followed by Post Hoc Tukey's test was used. Non-Parametric Data: Expressed as median (range); comparisons were performed using appropriate rank-based tests. Qualitative Variables: Reported as frequency and percentage; associations were examined using Chi-square test. Significance Thresholds: p ≤ 0.05: Statistically significant p 0.05: Not significant Ethical Considerations 1. Ethical Approval: The current protocol will be reviewed and approved by the Committee of Hepatology and Gastroenterology, the Committee of the Faculty of Medicine at Ain Shams University, and subsequently by the university’s central Ethics Committee 2. Informed Consent: Written informed consent will be obtained from all participants before enrollment. The consent process will align with international ethical standards and the procedures approved by the university’s ethics board. 3. Confidentiality and Data Protection: To ensure the privacy of participants: All identifying data (e.g., names, contacts) will be deleted at the end of the follow-up period. A unique serial identification number will be assigned to each participant. All data will be stored on password-protected systems with restricted access. 4. Management of Withdrawals: Participants who choose to withdraw will have their data securely separated from the main dataset. Attempts will be made to contact them for feedback to improve future study protocols. 5. Financial Considerations: Participants unable to afford necessary diagnostic procedures will be financially supported by the research team to ensure equity and continuity of care. Results Patient Cohort and Clinical Classification A total of 60 patients (age range: 37–80 years) were enrolled from Ain Shams University Hospitals following informed consent. Based on upper gastrointestinal endoscopy (UGIE), patients were classified into two groups: 32 (53.3%) with esophageal varices and 28 (46.7%) without. Demographic and Comorbidity Profile No statistically significant differences were observed between groups in terms of age ( p = 0.086), gender ( p = 0.714), smoking status ( p = 0.714), diabetes mellitus ( p = 0.366), or hypertension ( p = 0.143). These findings suggest comparable demographic and comorbidity profiles (Table 5). Laboratory Findings Patients with varices exhibited significantly lower platelet counts (median 66 vs. 152.5 ×10³/mm³, p < 0.001), lower serum albumin levels (2.70 ± 0.30 vs. 3.05 ± 0.59 g/dL, p = 0.005), and higher international normalized ratio (INR) values (1.42 ± 0.29 vs. 1.24 ± 0.18, p = 0.007). No statistically significant differences were noted in white blood cell count, hemoglobin, renal function parameters, electrolytes, liver enzymes, or bilirubin values (Table 6). Virological and Ultrasonographic Characteristics The prevalence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) did not differ significantly between groups ( p > 0.05). All patients were free of portal vein thrombosis (PVT) and hepatic focal lesions (HFL). Splenomegaly was significantly more common in patients with varices (93.8%) compared to those without (71.4%, p = 0.021). Ascites severity showed no statistically significant variation (Table 7). Liver Disease Scores and Biomarkers While Child-Pugh grade, Child score, and Model for End-Stage Liver Disease (MELD) score showed no statistically significant differences, patients with varices demonstrated pronounced abnormalities in three key biomarkers: Platelet count (PLT): 65.5 vs. 152.5 ×10³/mm³, p < 0.001 von Willebrand factor (VWF): 81.95 vs. 29.52 IU/dL, p < 0.001 VITRO score (VWF/PLT ratio): 1.22 vs. 0.23, p < 0.001 (Table 8) Correlation Analysis Spearman correlation revealed strong associations between the VITRO score and key clinical parameters: PLT: r = –0.829, p < 0.001 VWF: r = 0.596, p < 0.001 INR: r = 0.478, p < 0.001 Albumin: r = –0.316, p = 0.014 Child score: r = 0.282, p = 0.029 No statistically significant correlations were observed with MELD, liver enzymes, AFP, or general hematologic markers (Table 9). Diagnostic Accuracy and Predictive Modeling Receiver operating characteristic (ROC) curve analysis identified a VITRO cutoff of >0.82 as optimal for detecting esophageal varices: Area under the curve (AUC): 0.996 Sensitivity: 93.75% Specificity: 100% Positive predictive value (+PV): 100.0% Negative predictive value (–PV): 93.3% (Figure 1) Logistic regression analysis identified elevated VWF (>56.43 IU/dL) as the strongest independent predictor of varices (OR = 42.00, 95% CI: 9.472–186.226, p < 0.001). Platelet count, INR, and splenomegaly were also significant predictors in univariate analysis (Table 10). Discussion Over the past decades, considerable effort has been dedicated to identifying non-invasive serum biomarkers capable of predicting portal hypertension in chronic liver disease. The hepatic venous pressure gradient (HVPG) remains the gold standard for assessing portal hypertension in cirrhosis, offering independent prognostic insights into survival, decompensation risks, and complications. Among these, variceal bleeding is the most feared, with a 1-year mortality rate reaching up to 57%. Approximately 20% of deaths occur within six weeks of a bleeding episode (Mona Ahmed Abdelmaksoud et al., (8) . The VITRO score has emerged as a promising surrogate marker, with previous literature confirming its association with liver cirrhosis, portal hypertension, and esophageal varices. Our study sought to assess its utility in predicting CSPH and EVs non-invasively. Sixty cirrhotic patients were included, excluding those with portal vein thrombosis, veno-occlusive disease, hepatic focal lesions, or bilharzial/periportal fibrosis. Participants were stratified based on the presence or absence of EVs. In our cohort, the VITRO score was significantly higher among patients with EVs (median [IQR]: 1.22 [1.03–1.32], p = 0.00), consistent with findings from Hametner et al. (7), who demonstrated elevated scores among variceal patients ( p < 0.0001). Their reported medians were 2.6 [1.5–3.3] in compensated and 3.3 [1.8–4.2] in decompensated patients ( p < 0.014). Comparative analysis supports our results. Hassan et al. (9) documented a VITRO score AUC of 0.920 (95% CI: 0.835–0.969) with 75% sensitivity, 100% specificity, and 97.1% accuracy at a cut-off >1.3. Hametner et al (7). reported an AUC of 0.86 (CI: 0.81–0.91), sensitivity of 80%, and specificity of 70% for CSPH at a cut-off >1.58. Our study yielded superior performance, with an AUC of 0.996, sensitivity of 93.75%, specificity of 100%, PPV of 100%, and NPV of 93.3 at a cut-off >0.82. No significant correlations were found between VITRO score and age, WBCs, hemoglobin, BUN, creatinine, sodium, potassium, bilirubin (total/direct), AST, ALT, AFP, or MELD score. However, strong positive correlations were observed with INR, Child-Pugh score, and vWF-Ag—all elevated in EV-positive patients. Conversely, platelet count and serum albumin were significantly lower in those with varices. The high diagnostic accuracy of VITRO may be attributed to its integration of independent portal hypertension predictors—platelets and vWF-Ag. Several studies have identified thrombocytopenia as a key marker, often attributed to splenic sequestration. Hassan et al. (9) affirmed this relationship. Uong et al. (10) found that EVs predominated in patients with platelet counts between 50–99 giga/L, while those exceeding 150 giga/L were typically varice-free ( p < 0.0001). Cut-offs for EVs and large varices were 123 and 105 giga/L, respectively, aligning with our findings: median platelet count was 66 (58.8–91.5) in EV patients vs. 152.5 (107–216) in controls ( p = 0.00). vWF-Ag, a marker of endothelial dysfunction and vascular tone in cirrhosis, also correlated strongly with HVPG. Elevated levels reflect shear stress or bacterial translocation-driven synthesis (Hassan et al.,( 9), consistent with our study and that of Abdelmaksoud et al (11). Serum albumin showed a negative correlation with EV severity. Budiyasa et al. (12) reported r = –0.587 ( p < 0.01), and our cohort confirmed this relationship (mean albumin: 2.7 ± 0.3 g/dL in EV vs. 3.05 ± 0.59 g/dL in controls; p = 0.005). INR was notably higher in EV patients (1.42 ± 0.29 vs. 1.24 ± 0.18, p = 0.007), similar to Gomaa et al. (13). However, unlike Gomaa's findings, we did not observe significant associations between EV presence and Child grade ( p = 0.585), Child score ( p = 0.051), or MELD score ( p = 0.494). These discrepancies may be due to population differences or varying disease etiologies. Conclusion The VITRO score was significantly elevated in patients with esophageal varices. It demonstrated superior sensitivity and diagnostic accuracy compared to traditional markers such as platelet count, serum albumin, and INR. Its use may enhance non-invasive screening for clinically significant portal hypertension and esophageal varices—allowing for earlier intervention prior to life-threatening complications such as hematemesis or melena. This could reduce reliance on invasive procedures, ultimately improving patient stratification and clinical outcomes. Declarations Ethics, Consent to Participate, and Consent to Publish This study was approved by the Committee of Ethics at the Faculty of Medicine, Ain Shams University, Cairo, Egypt. Written informed consent was obtained from all participants prior to enrollment. Additionally, consent for the publication of anonymized data was acquired in accordance with both institutional and international ethical standards. Competing Interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Author Contribution S.S.G. conceptualized the study, oversaw the research protocol, and was responsible for manuscript drafting and corresponding revisions. H.S.M. contributed to patient recruitment, clinical data acquisition, and ELISA laboratory procedures. K.E.K. provided senior supervision, validated diagnostic classifications, and guided ethical approvals. H.H. performed statistical analysis, generated tables and figures, and assisted in final manuscript formatting. All authors reviewed and approved the final version of the manuscript. Data Availability Data AvailabilityThe clinical and laboratory datasets supporting the findings of this study are not publicly deposited due to patient confidentiality and institutional ethics guidelines. However, they are available from the corresponding author upon reasonable request. Please contact Salah Shaarawy Galal at:Email: [email protected] References Schuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838–851. Oliver TI, Sharma B, John S. Portal Hypertension. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. Vuille-Lessard É, Rodrigues SG, Berzigotti A. Noninvasive detection of clinically significant portal hypertension in compensated advanced chronic liver disease. Clinics in Liver Disease. 2021; 25(2):253-89. Moore AH. Thrombocytopenia in cirrhosis: a review of pathophysiology and management options. Clinical liver disease. 2019; 14(5):183. Zou Z, Yan X, Li C, et al. von Willebrand factor as a biomarker of clinically significant portal hypertension and severe portal hypertension: a systematic review and meta-analysis. BMJ Open 2019;9:e025656. Mahmoud HS, Ghweil AA, Bazeed SE, Fayed HM, Abdel Meguid MM. Reliability of plasma von Willebrand factor antigen in prediction of esophageal varices in patients with liver cirrhosis. Open J Gastroenterol. 2015;5:49–57. Hametner S, Ferlitsch A, Ferlitsch M, Etschmaier A, Schöfl R, Ziachehabi A, Maieron A. The VITRO score (Von Willebrand factor antigen/thrombocyte ratio) as a new marker for clinically significant portal hypertension in comparison to other non-invasive parameters of fibrosis including ELF test. PloS one. 2016; 11(2):e0149230. Mona A. AbdelMaksoud1, Amal A. Jouda1, Talaat Fathy1, Ahmad Mokhtar Ahmad Ibrahim2, Ahmad Sallam Soliman2, Ahmad Baraka2, Mohammad N. Elkhashab1 (2019): Role of Plasma Von Willebrand Factor-Antigen in Predicting the Presence of Esophageal Varices and Occurrence of its Bleeding in Cirrhotic Patients: a Cross Sectional Study 9(2):139-149 Hassan EA, Abd El AS, Sayed ZE, Ashmawy AM, Kholef EF, Sabry A, Elsewify WA. Noninvasive fibrosis scores as prognostic markers for varices needing treatment in advanced compensated liver cirrhosis. Open Journal of Gastroenterology. 2017; 7(8):230-42. Uong, P., Chey, V., Unn, K., Nov, N., Kang, K., Un, S., Kaing, K., Khuon, V., Ny, T., Mon, P., Kann, S., Chhit, D., Um, S., Chhay, K. and Sou, S. (2023) Correlation of Platelet Count with Grading of Esophageal Varices in Cirrhotic Patients. Open Journal of Gastroenterology, 13, 12-27 Abdelmaksoud MA, Jouda AA, Fathy T, Ibrahim AM, Soliman AS, Baraka A, Elkhashab MN. Role of Plasma Von Willebrand Factor-Antigen in predicting the presence of Esophageal Varices and occurrence of its bleeding in cirrhotic patients. Afro-Egyptian Journal of Infectious and Endemic Diseases. 2019; 9(2):139-49. Dewa Gde Agung Budiyasa, Yuna Ariawan, I Ketut Mariadi, I Dewa Nyoman Wibawa, Nyoman Purwadi, I Gusti Agung Suryadarma (2011): Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis,The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy (12) Gomaa AA, ElNaggar AA, Fawzy MM. Nonendoscopic predictors of large esophageal varices. Egypt J Intern Med. 2012;24(3):97–99. Tables Table 1. Baseline Demographic and Clinical Characteristics of the Study Population Total No.= 60 Groups No varices 28 (46.7%) varices 32 (53.3%) Age Mean ± SD 62.73 ± 10.78 Range 37 – 80 Gender Female 20 (33.3%) Male 40 (66.7%) Smoking No 40 (66.7%) Yes 20 (33.3%) DM No 42 (70.0%) Yes 18 (30.0%) HTN No 40 (66.7%) Yes 20 (33.3%) Data are presented as mean ± SD, median (IQR), or frequency (%), as appropriate. Table 2. Laboratory Findings Among All Patients Total No.= 60 WBCs Median (IQR) 5.9 (3.6 – 9.4) Range 1.7 – 18 Hb Mean ± SD 10.10 ± 2.45 Range 5.2 – 15 Platelets Median (IQR) 93 (61 – 145) Range 31 – 342 BUN Median (IQR) 20 (14 – 49) Range 8 – 121 Creat. Median (IQR) 0.9 (0.7 – 1.3) Range 0.5 – 7.3 Na Mean ± SD 136.80 ± 5.32 Range 120 – 145 K Mean ± SD 4.06 ± 0.51 Range 2.9 – 5.1 Total bilirubin Median (IQR) 0.95 (0.6 – 1.8) Range 0.3 – 10.3 Direct bilirubin Median (IQR) 0.5 (0.2 – 0.9) Range 0.1 – 6.4 AST Median (IQR) 44 (38 – 98) Range 13 – 204 ALT Median (IQR) 24 (18 – 52) Range 12 – 208 Albumin Mean ± SD 2.86 ± 0.49 Range 2 – 4 INR Mean ± SD 1.34 ± 0.26 Range 1 – 2.21 Data are expressed as median (IQR) or mean ± SD. No statistical tests were applied for group comparison. Table 3. Virological Markers, Imaging Findings, and Clinical Features HBsAg Negative Positive HCV Ab Negative Positive AFP Median (IQR) Range PVT No HFL No Splenomegaly No Yes Ascites No Moderate Mild Marked Esophagealvarices No Yes Data are presented as mean ± SD, median (IQR), or frequency (%), as appropriate. Table 4. Liver Disease Severity Scores and Biomarkers Total No.= 60 Child grade A 10 (16.7%) B 30 (50.0%) C 20 (33.3%) Child Score Median (IQR) 9 (7 – 10) Range 6 – 14 MELD Score Median (IQR) 13 (9 – 20) Range 7 – 29 PLT Median (IQR) 93.5 (62 – 145) Range 31 – 342 VWF Median (IQR) 74.1 (30.01 – 82.37) Range 17.14 – 112.7 VITRO score Median (IQR) 0.85 (0.25 – 1.26) Range 0.08 – 1.92 Data are presented as mean ± SD, median (IQR), or frequency (%), as appropriate. Table 5. Comparison of Demographics and Comorbidities Between Varices Groups No varices Varices Test value P-value Sig. No. = 28 No. = 32 Age Mean ± SD 65.29 ± 9.11 60.50 ± 11.74 1.745• 0.086 NS Range 46 – 77 37 – 80 Gender Female 10 (35.7%) 10 (31.2%) 0.134* 0.714 NS Male 18 (64.3%) 22 (68.8%) Smoking No 18 (64.3%) 22 (68.8%) 0.134* 0.714 NS Yes 10 (35.7%) 10 (31.2%) DM No 18 (64.3%) 24 (75.0%) 0.816* 0.366 NS Yes 10 (35.7%) 8 (25.0%) HTN No 16 (57.1%) 24 (75.0%) 2.143* 0.143 NS Yes 12 (42.9%) 8 (25.0%) P-value > 0.05: Not significant (NS); P-value < 0.05: Significant (S); P-value < 0.01: Highly significant (HS) *: Chi-square test •: Independent t-test ≠: Mann–Whitney U test There were no statistically significant differences between patients with and without esophageal varices in terms of age ( p = 0.086), gender ( p = 0.714), smoking status ( p = 0.714), diabetes mellitus ( p = 0.366), or hypertension ( p = 0.143). These findings suggest a comparable demographic and comorbidity profile between both groups, as confirmed by independent t -tests and chi-square analyses. Table 6. Laboratory Differences Between Varices and Non-Varices Groups No varices Varices Test value P-value Sig. No. = 28 No. = 32 WBCs Median (IQR) 6.15 (4 – 9.4) 4.4 (3.6 – 9.75) -0.297≠ 0.767 NS Range 1.7 – 11.7 2 – 18 Hb Mean ± SD 10.17 ± 2.56 10.04 ± 2.40 0.200• 0.843 NS Range 5.2 – 15 6.5 – 14.5 Platelets Median (IQR) 152.5 (107 – 216) 66 (58.5 – 91.5) -4.807≠ 0.000 HS Range 58 – 342 31 – 145 BUN Median (IQR) 14 (12 – 49) 21 (18 – 62) -1.130≠ 0.259 NS Range 10 – 121 8 – 112 Creat. Median (IQR) 0.85 (0.7 – 1.3) 0.95 (0.65 – 1.3) -0.060≠ 0.953 NS Range 0.6 – 3.9 0.5 – 7.3 Na Mean ± SD 135.79 ± 6.17 137.69 ± 4.35 -1.392• 0.169 NS Range 120 – 145 129 – 142 K Mean ± SD 4.01 ± 0.49 4.11 ± 0.54 -0.743• 0.460 NS Range 3.2 – 5.1 2.9 – 4.8 Total bilirubin Median (IQR) 0.95 (0.6 – 1.3) 0.8 (0.5 – 1.9) -0.268≠ 0.789 NS Range 0.3 – 3.3 0.4 – 10.3 Direct bilirubin Median (IQR) 0.5 (0.3 – 0.6) 0.25 (0.2 – 1) -0.509≠ 0.611 NS Range 0.1 – 1.3 0.1 – 6.4 AST Median (IQR) 44 (22 – 112) 47.5 (39 – 80.5) -0.237≠ 0.812 NS Range 13 – 204 18 – 156 ALT Median (IQR) 25 (18 – 52) 24 (21 – 47.5) 0.000≠ 1.000 NS Range 12 – 208 12 – 76 Albumin Mean ± SD 3.05 ± 0.59 2.70 ± 0.30 2.941• 0.005 HS Range 2 – 4 2 – 3.1 INR Mean ± SD 1.24 ± 0.18 1.42 ± 0.29 -2.813• 0.007 HS Range 1.04 – 1.62 1 – 2.21 P-value > 0.05: Not significant (NS); P-value < 0.05: Significant (S); P-value < 0.01: Highly significant (HS) *: Chi-square test •: Independent t-test ≠: Mann–Whitney U test There were no statistically significant differences between patients with and without esophageal varices in terms of WBC count ( p = 0.767), hemoglobin ( p = 0.259), blood urea nitrogen ( p = 0.953), creatinine ( p = 0.169), sodium ( p = 0.460), potassium ( p = 0.789), total bilirubin ( p = 0.611), direct bilirubin ( p = 0.812), AST ( p = 0.812), or ALT ( p = 1.000). These results were evaluated using independent t -tests (•) and Mann–Whitney U tests (≠), depending on data distribution.However, significant differences were noted in platelet count ( p < 0.001), serum albumin ( p = 0.005), and INR ( p = 0.007). Patients with varices exhibited marked thrombocytopenia, hypoalbuminemia, and elevated INR levels, highlighting impaired synthetic liver function and portal hypertension among this group. Table 7. Comparison of Imaging Features and Ascites Severity No varices Varices Test value P-value Sig. No. = 28 No. = 32 HBsAg Negative 26 (92.9%) 32 (100.0%) 2.365* 0.124 NS Positive 2 (7.1%) 0 (0.0%) HCV Ab Negative 2 (7.1%) 2 (6.2%) 0.019* 0.890 NS Positive 26 (92.9%) 30 (93.8%) AFP Median (IQR) 1.88 (1.35 – 5.15) 3.6 (1.63 – 22.4) -0.830≠ 0.406 NS Range 0.9 – 25 0.7 – 23.1 PVT No 28 (100.0%) 32 (100.0%) - - - HFL No 28 (100.0%) 32 (100.0%) - - - Splenomegaly No 8 (28.6%) 2 (6.2%) 5.357* 0.021 S Yes 20 (71.4%) 30 (93.8%) Ascites No 6 (21.4%) 4 (12.5%) 3.750* 0.290 NS Moderate 14 (50.0%) 14 (43.8%) Mild 6 (21.4%) 6 (18.8%) Marked 2 (7.1%) 8 (25.0%) P-value > 0.05: Not significant (NS); P-value < 0.05: Significant (S); P-value < 0.01: Highly significant (HS) *: Chi-square test •: Independent t-test ≠: Mann–Whitney U test There was no statistically significant difference between patients with and without esophageal varices in terms of hepatitis B surface antigen (HBsAg, p = 0.124), hepatitis C antibody (HCV Ab, p = 0.890), alpha-fetoprotein levels (AFP, p = 0.406), portal vein thrombosis (PVT, p = 0.110), or ascites severity ( p = 0.290). These parameters were assessed using chi-square (*) and Mann–Whitney U (≠) tests, with all p -values exceeding the threshold of significance. In contrast, splenomegaly was significantly more prevalent among patients with varices (93.8%) compared to those without (71.4%, p = 0.021), suggesting a strong association between spleen enlargement and portal hypertension Table 8. Biomarker Differences Including PLT, VWF, and VITRO Score No varices Varices Test value P-value Sig. No. = 28 No. = 32 Child grade A 6 (21.4%) 4 (12.5%) 1.071* 0.585 NS B 14 (50.0%) 16 (50.0%) C 8 (28.6%) 12 (37.5%) Child Score Median (IQR) 7.5 (7 – 10) 9 (7.5 – 10) -1.956≠ 0.051 NS Range 6 – 11 6 – 14 MELD Score Median (IQR) 13 (10 – 16) 13.5 (9 – 22) -0.684≠ 0.494 NS Range 7 – 26 8 – 29 PLT Median (IQR) 152.5 (107 – 216) 65.5 (58.5 – 91.5) -4.746≠ 0.000 HS Range 58 – 342 31 – 145 VWF Median (IQR) 29.52 (26.84 – 46.96) 81.95 (75.61 – 96.28) -5.516≠ 0.000 HS Range 17.14 – 86.52 45.61 – 112.7 VITRO score Median (IQR) 0.23 (0.15 – 0.4) 1.22 (1.03 – 1.32) -6.582≠ 0.000 HS Range 0.08 – 0.82 0.78 – 1.92 P-value > 0.05: Not significant (NS); P-value < 0.05: Significant (S); P-value < 0.01: Highly significant (HS) *: Chi-square test •: Independent t-test ≠: Mann–Whitney U test Patients with esophageal varices demonstrated statistically significant differences in liver disease severity metrics. Child-Pugh grades and scores showed notable distribution shifts between the groups, though the difference approached but did not reach conventional levels of significance (p = 0.051). MELD scores also showed no significant variation. In contrast, platelet count, von Willebrand factor (VWF), and VITRO score were markedly altered in varices patients—indicating advanced portal hypertension. Specifically, platelet levels were significantly lower, while both VWF and VITRO scores were significantly elevated in the varices group (p < 0.001 for all comparisons, Mann–Whitney U test ≠). These findings underscore the diagnostic relevance of these biomarkers in predicting variceal presence. Table 9. Correlation Between VITRO Score and Clinical Parameters VITRO score r P-value Age -0.128 0.330 WBCs -0.220 0.091 Hb -0.230 0.076 BUN 0.156 0.234 Creat. -0.111 0.396 Na 0.179 0.171 K 0.052 0.696 Total bilirubin 0.065 0.622 Direct bilirubin -0.009 0.946 AST 0.120 0.359 ALT 0.123 0.350 Albumin -0.316* 0.014 INR 0.478** 0.000 AFP 0.117 0.512 Child Score 0.282* 0.029 MELD Score 0.125 0.342 PLT -0.829** 0.000 VWF 0.596** 0.000 Spearman correlation analysis revealed no statistically significant associations between the VITRO score and age, WBC count, hemoglobin, BUN, creatinine, sodium, potassium, total and direct bilirubin, AST, ALT, AFP, or MELD score (p > 0.05). In contrast, significant correlations were observed with serum albumin (r = –0.316, p = 0.014), INR (r = 0.478, p < 0.001), Child score (r = 0.282, p = 0.029), platelet count (r = –0.829, p < 0.001), and VWF (r = 0.596, p < 0.001). Elevated VITRO scores were associated with hypoalbuminemia, thrombocytopenia, increased INR, and higher Child scores—supporting its utility in assessing disease severity and variceal risk. Table 10. Logistic Regression Analysis Predicting Presence of Esophageal Varices Univariate Multivariate P-value Odds ratio (OR) 95% C.I. for OR P-value Odds ratio (OR) 95% C.I. for OR Lower Upper Lower Upper Platelets ≤ 93 0.000 42.000 9.472 186.226 – – – – INR >1.35 0.006 6.000 1.693 21.262 – – – – Splenomegaly 0.033 6.000 1.153 31.228 – – – – VWF >56.43 0.000 42.000 9.472 186.226 0.000 42.000 9.472 186.226 Logistic regression analysis identified significant associations between esophageal varices and platelet count, INR, splenomegaly, and von Willebrand factor (VWF) levels (p < 0.05 for all). Among these, elevated VWF emerged as the strongest independent predictor of variceal presence (OR = 42.00, 95% CI: 9.472–186.226, p < 0.001). Furthermore, the VITRO score demonstrated perfect specificity (100%) in discriminating patients with varices, underscoring its potential as a non-invasive diagnostic tool. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7124577","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":489900172,"identity":"7af39103-13d3-4c3a-a958-0f4147fc36d5","order_by":0,"name":"Hala Saleh Muhammad","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Hala","middleName":"Saleh","lastName":"Muhammad","suffix":""},{"id":489900173,"identity":"746684ee-3377-4f9d-816a-a3be0f7b67a4","order_by":1,"name":"Khaled El Karmoty","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Khaled","middleName":"El","lastName":"Karmoty","suffix":""},{"id":489900174,"identity":"9ec9190b-88c9-425a-85f4-2e802b6d25d8","order_by":2,"name":"Hesham Hamdy","email":"","orcid":"","institution":"Ain Shams University","correspondingAuthor":false,"prefix":"","firstName":"Hesham","middleName":"","lastName":"Hamdy","suffix":""},{"id":489900175,"identity":"3d89004e-15e2-42dc-90ff-ed341cfa7ffa","order_by":3,"name":"Salah Shaarawy","email":"data:image/png;base64,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","orcid":"","institution":"Ain Shams University","correspondingAuthor":true,"prefix":"","firstName":"Salah","middleName":"","lastName":"Shaarawy","suffix":""}],"badges":[],"createdAt":"2025-07-14 21:53:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7124577/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7124577/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87728198,"identity":"5717f107-edae-4230-a869-090e685c296e","added_by":"auto","created_at":"2025-07-28 11:07:53","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":32586,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eROC Curve for VITRO Score in Predicting Esophageal Varices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eReceiver operating characteristic (ROC) curve illustrating the performance of the VITRO score in identifying esophageal varices. A cutoff value \u0026gt;0.82 yielded an AUC of 0.996, with sensitivity of 93.75% and specificity of 100%. The score demonstrated outstanding discriminative ability with a positive predictive value of 100% and a negative predictive value of 93.3%.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7124577/v1/b65957c67aa4409675a391d2.png"},{"id":87729997,"identity":"6199a910-d924-43cf-a248-16dad803cfee","added_by":"auto","created_at":"2025-07-28 11:23:54","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1594953,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7124577/v1/ef105295-94d5-4622-bfe0-477ae5d90993.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluation of the VITRO Score as a Non-Invasive Marker for Esophageal Varices in Liver Cirrhosis","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCirrhosis is characterized by the histological presence of regenerative nodules surrounded by fibrous bands, resulting from chronic liver injury. This architectural distortion leads to increased intrahepatic resistance, impaired hepatocellular function, and a heightened risk of hepatocellular carcinoma (HCC) (1 ).\u003c/p\u003e\u003cp\u003eA major consequence of cirrhosis is portal hypertension, defined by a portal pressure gradient exceeding 5 mmHg. Clinically significant portal hypertension (CSPH) is established when this gradient surpasses 10 mmHg, prompting the development of portosystemic collaterals such as gastroesophageal varices and elevating the risk of decompensation events including ascites, variceal bleeding, and hepatic encephalopathy (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) ( 3).\u003c/p\u003e\u003cp\u003eThrombocytopenia, often the earliest hematological abnormality in chronic liver disease, is commonly attributed to splenic sequestration in the setting of portal hypertension. Additional factors—such as reduced thrombopoietin (TPO) levels associated with progressive fibrosis, alcohol-related marrow suppression, viral hepatitis, autoimmune destruction, and sepsis—also contribute to diminished platelet counts (\u0026lt; 150,000/µL) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVon Willebrand factor antigen (vWF-Ag), released by activated endothelial cells, serves as a marker of endothelial dysfunction. Its levels are elevated in cirrhotic patients, reflecting both the severity of fibrosis and portal hypertension. vWF concentrations also correlate with the degree of endotoxemia—attributable to intestinal dysbiosis, impaired hepatic clearance, and microbial translocation to mesenteric lymph nodes (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e) ( 6).\u003c/p\u003e\u003cp\u003eGiven that both thrombocytopenia and vWF-Ag are associated with the presence and severity of CSPH, they can be jointly applied through the VITRO score. This score has shown promise as a non-invasive diagnostic tool for portal hypertension and esophageal varices. Based on existing evidence (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), we hypothesize that the VITRO score may offer enhanced diagnostic accuracy in detecting CSPH.\u003c/p\u003e\u003cp\u003e\u003cb\u003eAIM OF THE WORK\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTo evaluate the vitro score as a non-invasive marker for presence of esophageal varices in clinically significant portal hypertension.\u003c/p\u003e"},{"header":"Patients and Methods","content":"\u003cp\u003eThis comparative cross-sectional study was conducted at the Internal Medicine and Hepatology outpatient clinics and inpatient wards of Ain Shams University Hospitals between January and June 2023. The study included 60 Egyptian patients aged 37–80 years with sonographically confirmed liver cirrhosis, recruited after obtaining written informed consent.\u003c/p\u003e\u003cp\u003ePatients were categorized into two groups based on the presence or absence of esophageal varices, as assessed by upper gastrointestinal endoscopy (UGIE).\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eInclusion Criteria\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eAdults (\u0026gt; 18 years) with liver cirrhosis confirmed by pelvi-abdominal ultrasound.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldUnderline\" class=\"BoldUnderline\" name=\"Emphasis\"\u003eExclusion Criteria\u003c/span\u003e:\u003c/p\u003e\u003cp\u003ePatients ≤ 18 years, those presenting with hematemesis and/or melena, and individuals with ultrasound findings indicative of portal vein thrombosis, veno-occlusive disease, hepatic focal lesions suggestive of hepatocellular carcinoma, or bilharzial/periportal fibrosis.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"BoldItalicUnderline\" class=\"BoldItalicUnderline\" name=\"Emphasis\"\u003eMethodology\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eAll enrolled patients underwent:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eComprehensive History Taking: Including past medical history of liver disease, signs of hepatic decompensation (ascites, encephalopathy, bleeding episodes), extrahepatic manifestations, and systemic symptoms.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePhysical Examination: General and focused evaluation for stigmata of chronic liver disease.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLaboratory Investigations:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eComplete blood count (CBC)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eLiver function tests: AST, ALT, total and direct bilirubin, serum albumin\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eCoagulation profile: PT, PTT, INR\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eRenal function: BUN, serum creatinine, sodium, potassium\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eViral markers: HCV antibody, HBsAg\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTumor marker: alpha-fetoprotein (AFP)\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eVon Willebrand Factor Antigen (vWF-Ag)\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eRadiological Assessment and Endoscopy\u003c/b\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eAbdominal Ultrasound: Performed after a 7-hour fast in the supine position. Parameters evaluated included liver size, echogenicity (bright/coarse), splenic bipolar diameter, portal vein diameter, and any hepatic focal lesions.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eUpper Gastrointestinal Endoscopy: Used to determine presence and grade of esophageal varices.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003evWF-Ag Assay Protocol\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe vWF antigen was measured using a quantitative Enzyme-Linked Immunosorbent Assay (ELISA) kit. Briefly:\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eMicroplate wells were pre-coated with human vWF Ag antibody.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSamples were added, followed by biotinylated anti-vWF antibody and Streptavidin-HRP.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAfter incubation and washing, substrate was added, and the reaction was terminated with acid stop solution.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eAbsorbance was measured at 450 nm.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eResults were calculated using a standard curve generated via regression analysis using OD values plotted against known concentrations.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003ch2\u003eStatistical Analysis\u003c/h2\u003e\u003cp\u003eData were analyzed using SPSS version 10.0 (Windows). Microsoft PowerPoint was used for chart generation.\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eQuantitative Variables: Presented as mean ± SD. Comparisons between two groups were made using Student’s t-test; for three-group comparisons, one-way ANOVA followed by Post Hoc Tukey's test was used.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eNon-Parametric Data: Expressed as median (range); comparisons were performed using appropriate rank-based tests.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eQualitative Variables: Reported as frequency and percentage; associations were examined using Chi-square test.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eSignificance Thresholds:\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e ≤ 0.05: Statistically significant\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01: Highly significant\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05: Not significant\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003cp\u003e\u003cb\u003eEthical Considerations\u003c/b\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e1. Ethical Approval:\u003c/strong\u003e\u003cbr\u003eThe current protocol will be reviewed and approved by the Committee of Hepatology and Gastroenterology, the Committee of the Faculty of Medicine at Ain Shams University, and subsequently by the university\u0026rsquo;s central Ethics Committee\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2. Informed Consent:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Written informed consent will be obtained from all participants before enrollment. The consent process will align with international ethical standards and the procedures approved by the university\u0026rsquo;s ethics board.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Confidentiality and Data Protection:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;To ensure the privacy of participants:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eAll identifying data (e.g., names, contacts) will be deleted at the end of the follow-up period.\u003c/li\u003e\n \u003cli\u003eA unique serial identification number will be assigned to each participant.\u003c/li\u003e\n \u003cli\u003eAll data will be stored on password-protected systems with restricted access.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003e4. Management of Withdrawals:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Participants who choose to withdraw will have their data securely separated from the main dataset. Attempts will be made to contact them for feedback to improve future study protocols.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e5. Financial Considerations:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Participants unable to afford necessary diagnostic procedures will be financially supported by the research team to ensure equity and continuity of care.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003ePatient Cohort and Clinical Classification\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 60 patients (age range: 37\u0026ndash;80 years) were enrolled from Ain Shams University Hospitals following informed consent. Based on upper gastrointestinal endoscopy (UGIE), patients were classified into two groups: 32 (53.3%) with esophageal varices and 28 (46.7%) without.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDemographic and Comorbidity Profile\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo statistically significant differences were observed between groups in terms of age (\u003cem\u003ep\u003c/em\u003e = 0.086), gender (\u003cem\u003ep\u003c/em\u003e = 0.714), smoking status (\u003cem\u003ep\u003c/em\u003e = 0.714), diabetes mellitus (\u003cem\u003ep\u003c/em\u003e = 0.366), or hypertension (\u003cem\u003ep\u003c/em\u003e = 0.143). These findings suggest comparable demographic and comorbidity profiles (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLaboratory Findings\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePatients with varices exhibited significantly lower platelet counts (median 66 vs. 152.5 \u0026times;10\u0026sup3;/mm\u0026sup3;, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), lower serum albumin levels (2.70 \u0026plusmn; 0.30 vs. 3.05 \u0026plusmn; 0.59 g/dL, \u003cem\u003ep\u003c/em\u003e = 0.005), and higher international normalized ratio (INR) values (1.42 \u0026plusmn; 0.29 vs. 1.24 \u0026plusmn; 0.18, \u003cem\u003ep\u003c/em\u003e = 0.007). No statistically significant differences were noted in white blood cell count, hemoglobin, renal function parameters, electrolytes, liver enzymes, or bilirubin values (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eVirological and Ultrasonographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe prevalence of hepatitis B surface antigen (HBsAg) and hepatitis C antibody (HCV Ab) did not differ significantly between groups (\u003cem\u003ep\u003c/em\u003e \u0026gt; 0.05). All patients were free of portal vein thrombosis (PVT) and hepatic focal lesions (HFL). Splenomegaly was significantly more common in patients with varices (93.8%) compared to those without (71.4%, \u003cem\u003ep\u003c/em\u003e = 0.021). Ascites severity showed no statistically significant variation (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLiver Disease Scores and Biomarkers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhile Child-Pugh grade, Child score, and Model for End-Stage Liver Disease (MELD) score showed no statistically significant differences, patients with varices demonstrated pronounced abnormalities in three key biomarkers:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePlatelet count (PLT): 65.5 vs. 152.5 \u0026times;10\u0026sup3;/mm\u0026sup3;, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/li\u003e\n \u003cli\u003evon Willebrand factor (VWF): 81.95 vs. 29.52 IU/dL, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/li\u003e\n \u003cli\u003eVITRO score (VWF/PLT ratio): 1.22 vs. 0.23,\u0026nbsp;\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003cbr\u003e\u0026nbsp;(Table 8)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelation Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSpearman correlation revealed strong associations between the VITRO score and key clinical parameters:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003ePLT: \u003cem\u003er\u003c/em\u003e = \u0026ndash;0.829, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/li\u003e\n \u003cli\u003eVWF: \u003cem\u003er\u003c/em\u003e = 0.596, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/li\u003e\n \u003cli\u003eINR: \u003cem\u003er\u003c/em\u003e = 0.478, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001\u003c/li\u003e\n \u003cli\u003eAlbumin: \u003cem\u003er\u003c/em\u003e = \u0026ndash;0.316, \u003cem\u003ep\u003c/em\u003e = 0.014\u003c/li\u003e\n \u003cli\u003eChild score: \u003cem\u003er\u003c/em\u003e = 0.282, \u003cem\u003ep\u003c/em\u003e = 0.029\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eNo statistically significant correlations were observed with MELD, liver enzymes, AFP, or general hematologic markers (Table 9).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDiagnostic Accuracy and Predictive Modeling\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eReceiver operating characteristic (ROC) curve analysis identified a VITRO cutoff of \u0026gt;0.82 as optimal for detecting esophageal varices:\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003eArea under the curve (AUC): 0.996\u003c/li\u003e\n \u003cli\u003eSensitivity: 93.75%\u003c/li\u003e\n \u003cli\u003eSpecificity: 100%\u003c/li\u003e\n \u003cli\u003ePositive predictive value (+PV): 100.0%\u003c/li\u003e\n \u003cli\u003eNegative predictive value (\u0026ndash;PV): 93.3%\u003cbr\u003e\u0026nbsp;(Figure 1)\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eLogistic regression analysis identified elevated VWF (\u0026gt;56.43 IU/dL) as the strongest independent predictor of varices (OR = 42.00, 95% CI: 9.472\u0026ndash;186.226, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001). Platelet count, INR, and splenomegaly were also significant predictors in univariate analysis (Table 10).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eOver the past decades, considerable effort has been dedicated to identifying non-invasive serum biomarkers capable of predicting portal hypertension in chronic liver disease. The hepatic venous pressure gradient (HVPG) remains the gold standard for assessing portal hypertension in cirrhosis, offering independent prognostic insights into survival, decompensation risks, and complications. Among these, variceal bleeding is the most feared, with a 1-year mortality rate reaching up to 57%. Approximately 20% of deaths occur within six weeks of a bleeding episode (Mona Ahmed Abdelmaksoud et al., (8) .\u003c/p\u003e\n\u003cp\u003eThe VITRO score has emerged as a promising surrogate marker, with previous literature confirming its association with liver cirrhosis, portal hypertension, and esophageal varices. Our study sought to assess its utility in predicting CSPH and EVs non-invasively. Sixty cirrhotic patients were included, excluding those with portal vein thrombosis, veno-occlusive disease, hepatic focal lesions, or bilharzial/periportal fibrosis. Participants were stratified based on the presence or absence of EVs.\u003c/p\u003e\n\u003cp\u003eIn our cohort, the VITRO score was significantly higher among patients with EVs (median [IQR]: 1.22 [1.03\u0026ndash;1.32], \u003cem\u003ep\u003c/em\u003e = 0.00), consistent with findings from Hametner et al. (7), who demonstrated elevated scores among variceal patients (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001). Their reported medians were 2.6 [1.5\u0026ndash;3.3] in compensated and 3.3 [1.8\u0026ndash;4.2] in decompensated patients (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.014).\u003c/p\u003e\n\u003cp\u003eComparative analysis supports our results. Hassan et al. (9) documented a VITRO score AUC of 0.920 (95% CI: 0.835\u0026ndash;0.969) with 75% sensitivity, 100% specificity, and 97.1% accuracy at a cut-off \u0026gt;1.3. Hametner et al (7). reported an AUC of 0.86 (CI: 0.81\u0026ndash;0.91), sensitivity of 80%, and specificity of 70% for CSPH at a cut-off \u0026gt;1.58. Our study yielded superior performance, with an AUC of 0.996, sensitivity of 93.75%, specificity of 100%, PPV of 100%, and NPV of 93.3 at a cut-off \u0026gt;0.82.\u003c/p\u003e\n\u003cp\u003eNo significant correlations were found between VITRO score and age, WBCs, hemoglobin, BUN, creatinine, sodium, potassium, bilirubin (total/direct), AST, ALT, AFP, or MELD score. However, strong positive correlations were observed with INR, Child-Pugh score, and vWF-Ag\u0026mdash;all elevated in EV-positive patients. Conversely, platelet count and serum albumin were significantly lower in those with varices.\u003c/p\u003e\n\u003cp\u003eThe high diagnostic accuracy of VITRO may be attributed to its integration of independent portal hypertension predictors\u0026mdash;platelets and vWF-Ag. Several studies have identified thrombocytopenia as a key marker, often attributed to splenic sequestration. Hassan et al. (9) affirmed this relationship. Uong et al. (10) found that EVs predominated in patients with platelet counts between 50\u0026ndash;99 giga/L, while those exceeding 150 giga/L were typically varice-free (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.0001). Cut-offs for EVs and large varices were 123 and 105 giga/L, respectively, aligning with our findings: median platelet count was 66 (58.8\u0026ndash;91.5) in EV patients vs. 152.5 (107\u0026ndash;216) in controls (\u003cem\u003ep\u003c/em\u003e = 0.00).\u003c/p\u003e\n\u003cp\u003evWF-Ag, a marker of endothelial dysfunction and vascular tone in cirrhosis, also correlated strongly with HVPG. Elevated levels reflect shear stress or bacterial translocation-driven synthesis (Hassan et al.,( 9), consistent with our study and that of Abdelmaksoud et al (11).\u003c/p\u003e\n\u003cp\u003eSerum albumin showed a negative correlation with EV severity. Budiyasa et al. (12) reported r = \u0026ndash;0.587 (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.01), and our cohort confirmed this relationship (mean albumin: 2.7 \u0026plusmn; 0.3 g/dL in EV vs. 3.05 \u0026plusmn; 0.59 g/dL in controls; \u003cem\u003ep\u003c/em\u003e = 0.005).\u003c/p\u003e\n\u003cp\u003eINR was notably higher in EV patients (1.42 \u0026plusmn; 0.29 vs. 1.24 \u0026plusmn; 0.18, \u003cem\u003ep\u003c/em\u003e = 0.007), similar to Gomaa et al. (13). However, unlike Gomaa\u0026apos;s findings, we did not observe significant associations between EV presence and Child grade (\u003cem\u003ep\u003c/em\u003e = 0.585), Child score (\u003cem\u003ep\u003c/em\u003e = 0.051), or MELD score (\u003cem\u003ep\u003c/em\u003e = 0.494). These discrepancies may be due to population differences or varying disease etiologies.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe VITRO score was significantly elevated in patients with esophageal varices. It demonstrated superior sensitivity and diagnostic accuracy compared to traditional markers such as platelet count, serum albumin, and INR. Its use may enhance non-invasive screening for clinically significant portal hypertension and esophageal varices\u0026mdash;allowing for earlier intervention prior to life-threatening complications such as hematemesis or melena. This could reduce reliance on invasive procedures, ultimately improving patient stratification and clinical outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics, Consent to Participate, and Consent to Publish\u003c/h2\u003e\u003cp\u003e This study was approved by the Committee of Ethics at the Faculty of Medicine, Ain Shams University, Cairo, Egypt. Written informed consent was obtained from all participants prior to enrollment. Additionally, consent for the publication of anonymized data was acquired in accordance with both institutional and international ethical standards.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting Interests\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.S.G. conceptualized the study, oversaw the research protocol, and was responsible for manuscript drafting and corresponding revisions. H.S.M. contributed to patient recruitment, clinical data acquisition, and ELISA laboratory procedures. K.E.K. provided senior supervision, validated diagnostic classifications, and guided ethical approvals. H.H. performed statistical analysis, generated tables and figures, and assisted in final manuscript formatting. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eData AvailabilityThe clinical and laboratory datasets supporting the findings of this study are not publicly deposited due to patient confidentiality and institutional ethics guidelines. However, they are available from the corresponding author upon reasonable request. Please contact Salah Shaarawy Galal at:Email: [email protected]\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSchuppan D, Afdhal NH. Liver cirrhosis. Lancet. 2008;371(9615):838\u0026ndash;851. \u003c/li\u003e\n\u003cli\u003eOliver TI, Sharma B, John S. Portal Hypertension. [Updated 2022 May 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022. \u003c/li\u003e\n\u003cli\u003eVuille-Lessard \u0026Eacute;, Rodrigues SG, Berzigotti A. Noninvasive detection of clinically significant portal hypertension in compensated advanced chronic liver disease. Clinics in Liver Disease. 2021; 25(2):253-89.\u003c/li\u003e\n\u003cli\u003eMoore AH. Thrombocytopenia in cirrhosis: a review of pathophysiology and management options. Clinical liver disease. 2019; 14(5):183.\u003c/li\u003e\n\u003cli\u003eZou Z, Yan X, Li C, et al. von Willebrand factor as a biomarker of clinically significant portal hypertension and severe portal hypertension: a systematic review and meta-analysis. BMJ Open 2019;9:e025656. \u003c/li\u003e\n\u003cli\u003eMahmoud HS, Ghweil AA, Bazeed SE, Fayed HM, Abdel Meguid MM. Reliability of plasma von Willebrand factor antigen in prediction of esophageal varices in patients with liver cirrhosis. Open J Gastroenterol. 2015;5:49\u0026ndash;57. \u003c/li\u003e\n\u003cli\u003eHametner S, Ferlitsch A, Ferlitsch M, Etschmaier A, Sch\u0026ouml;fl R, Ziachehabi A, Maieron A. The VITRO score (Von Willebrand factor antigen/thrombocyte ratio) as a new marker for clinically significant portal hypertension in comparison to other non-invasive parameters of fibrosis including ELF test. PloS one. 2016; 11(2):e0149230.\u003c/li\u003e\n\u003cli\u003eMona A. AbdelMaksoud1, Amal A. Jouda1, Talaat Fathy1, Ahmad Mokhtar Ahmad Ibrahim2, Ahmad Sallam Soliman2, Ahmad Baraka2, Mohammad N. Elkhashab1 (2019): Role of Plasma Von Willebrand Factor-Antigen in Predicting the Presence of Esophageal Varices and Occurrence of its Bleeding in Cirrhotic Patients: a Cross Sectional Study 9(2):139-149\u003c/li\u003e\n\u003cli\u003eHassan EA, Abd El AS, Sayed ZE, Ashmawy AM, Kholef EF, Sabry A, Elsewify WA. Noninvasive fibrosis scores as prognostic markers for varices needing treatment in advanced compensated liver cirrhosis. Open Journal of Gastroenterology. 2017; 7(8):230-42.\u003c/li\u003e\n\u003cli\u003eUong, P., Chey, V., Unn, K., Nov, N., Kang, K., Un, S., Kaing, K., Khuon, V., Ny, T., Mon, P., Kann, S., Chhit, D., Um, S., Chhay, K. and Sou, S. (2023) Correlation of Platelet Count with Grading of Esophageal Varices in Cirrhotic Patients. Open Journal of Gastroenterology, 13, 12-27\u003c/li\u003e\n\u003cli\u003eAbdelmaksoud MA, Jouda AA, Fathy T, Ibrahim AM, Soliman AS, Baraka A, Elkhashab MN. Role of Plasma Von Willebrand Factor-Antigen in predicting the presence of Esophageal Varices and occurrence of its bleeding in cirrhotic patients. Afro-Egyptian Journal of Infectious and Endemic Diseases. 2019; 9(2):139-49.\u003c/li\u003e\n\u003cli\u003eDewa Gde Agung Budiyasa, Yuna Ariawan, I Ketut Mariadi, I Dewa Nyoman Wibawa, Nyoman Purwadi, I Gusti Agung Suryadarma (2011): Correlation between Serum Albumin Level and Degree of Esophageal Varices in Patients with Liver Cirrhosis,The Indonesian Journal of Gastroenterology, Hepatology, and Digestive Endoscopy (12)\u003c/li\u003e\n\u003cli\u003eGomaa AA, ElNaggar AA, Fawzy MM. Nonendoscopic predictors of large esophageal varices. Egypt J Intern Med. 2012;24(3):97\u0026ndash;99. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Baseline Demographic and Clinical Characteristics of the Study Population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No.= 60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGroups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo varices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e28 (46.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003evarices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e32 (53.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e62.73 \u0026plusmn; 10.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRange\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e37 \u0026ndash; 80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e20 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e40 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e40 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e20 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e42 (70.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e18 (30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHTN\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e40 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 28px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e20 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD, median (IQR), or frequency (%), as appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Laboratory Findings Among All Patients\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No.= 60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eWBCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e5.9 (3.6 \u0026ndash; 9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e1.7 \u0026ndash; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e10.10 \u0026plusmn; 2.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e5.2 \u0026ndash; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e93 (61 \u0026ndash; 145)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e31 \u0026ndash; 342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eBUN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e20 (14 \u0026ndash; 49)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e8 \u0026ndash; 121\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eCreat.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.9 (0.7 \u0026ndash; 1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eNa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e136.80 \u0026plusmn; 5.32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e120 \u0026ndash; 145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e4.06 \u0026plusmn; 0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e2.9 \u0026ndash; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eTotal bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.95 (0.6 \u0026ndash; 1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.3 \u0026ndash; 10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eDirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.5 (0.2 \u0026ndash; 0.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e0.1 \u0026ndash; 6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e44 (38 \u0026ndash; 98)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e13 \u0026ndash; 204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e24 (18 \u0026ndash; 52)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e12 \u0026ndash; 208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e2.86 \u0026plusmn; 0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e2 \u0026ndash; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 23px;\"\u003e\n \u003cp\u003eINR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e1.34 \u0026plusmn; 0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 24px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 52px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are expressed as median (IQR) or mean \u0026plusmn; SD. No statistical tests were applied for group comparison.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Virological Markers, Imaging Findings, and Clinical Features\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eHBsAg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eHCV Ab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAFP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003ePVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 58px;\"\u003e\n \u003cp\u003eHFL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eSplenomegaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 58px;\"\u003e\n \u003cp\u003eAscites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eMarked\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 58px;\"\u003e\n \u003cp\u003eEsophagealvarices\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 41px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD, median (IQR), or frequency (%), as appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Liver Disease Severity Scores and Biomarkers\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal No.= 60\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 27px;\"\u003e\n \u003cp\u003eChild grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e10 (16.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e30 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e20 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003eChild Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e9 (7 \u0026ndash; 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e6 \u0026ndash; 14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003eMELD Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e13 (9 \u0026ndash; 20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e7 \u0026ndash; 29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e93.5 (62 \u0026ndash; 145)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e31 \u0026ndash; 342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003eVWF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e74.1 (30.01 \u0026ndash; 82.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e17.14 \u0026ndash; 112.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 27px;\"\u003e\n \u003cp\u003eVITRO score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.85 (0.25 \u0026ndash; 1.26)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 22px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 50px;\"\u003e\n \u003cp\u003e0.08 \u0026ndash; 1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eData are presented as mean \u0026plusmn; SD, median (IQR), or frequency (%), as appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Comparison of Demographics and Comorbidities Between Varices Groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 26px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo varices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVarices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e65.29 \u0026plusmn; 9.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e60.50 \u0026plusmn; 11.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e1.745\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e46 \u0026ndash; 77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e37 \u0026ndash; 80\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.134*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e18 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e22 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eSmoking\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e18 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e22 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.134*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.714\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eDM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e18 (64.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e24 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.816*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 (35.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eHTN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e16 (57.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e24 (75.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.143*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003e0.143\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 10px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e12 (42.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eP-value \u0026gt; 0.05: Not significant (NS); P-value \u0026lt; 0.05: Significant (S); P-value \u0026lt; 0.01: Highly significant (HS) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*: Chi-square test\u0026emsp;\u0026bull;: Independent t-test\u0026emsp;\u0026ne;: Mann\u0026ndash;Whitney U test\u003c/p\u003e\n\u003cp\u003eThere were no statistically significant differences between patients with and without esophageal varices in terms of age (\u003cem\u003ep\u003c/em\u003e = 0.086), gender (\u003cem\u003ep\u003c/em\u003e = 0.714), smoking status (\u003cem\u003ep\u003c/em\u003e = 0.714), diabetes mellitus (\u003cem\u003ep\u003c/em\u003e = 0.366), or hypertension (\u003cem\u003ep\u003c/em\u003e = 0.143). These findings suggest a comparable demographic and comorbidity profile between both groups, as confirmed by independent \u003cem\u003et\u003c/em\u003e-tests and chi-square analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Laboratory Differences Between Varices and Non-Varices Groups\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"99%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo varices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVarices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eWBCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6.15 (4 \u0026ndash; 9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e4.4 (3.6 \u0026ndash; 9.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.297\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.767\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.7 \u0026ndash; 11.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2 \u0026ndash; 18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10.17 \u0026plusmn; 2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e10.04 \u0026plusmn; 2.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.200\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.843\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e5.2 \u0026ndash; 15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e6.5 \u0026ndash; 14.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003ePlatelets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e152.5 (107 \u0026ndash; 216)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e66 (58.5 \u0026ndash; 91.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-4.807\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e58 \u0026ndash; 342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e31 \u0026ndash; 145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eBUN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e14 (12 \u0026ndash; 49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e21 (18 \u0026ndash; 62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-1.130\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e10 \u0026ndash; 121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e8 \u0026ndash; 112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eCreat.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.85 (0.7 \u0026ndash; 1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.95 (0.65 \u0026ndash; 1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.060\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.953\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.6 \u0026ndash; 3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.5 \u0026ndash; 7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eNa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e135.79 \u0026plusmn; 6.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e137.69 \u0026plusmn; 4.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-1.392\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e120 \u0026ndash; 145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e129 \u0026ndash; 142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e4.01 \u0026plusmn; 0.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e4.11 \u0026plusmn; 0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.743\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3.2 \u0026ndash; 5.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2.9 \u0026ndash; 4.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eTotal bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.95 (0.6 \u0026ndash; 1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.8 (0.5 \u0026ndash; 1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.268\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.789\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.3 \u0026ndash; 3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.4 \u0026ndash; 10.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eDirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.5 (0.3 \u0026ndash; 0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.25 (0.2 \u0026ndash; 1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.509\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.611\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.1 \u0026ndash; 1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.1 \u0026ndash; 6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e44 (22 \u0026ndash; 112)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e47.5 (39 \u0026ndash; 80.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.237\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e13 \u0026ndash; 204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e18 \u0026ndash; 156\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e25 (18 \u0026ndash; 52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e24 (21 \u0026ndash; 47.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e0.000\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e12 \u0026ndash; 208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e12 \u0026ndash; 76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e3.05 \u0026plusmn; 0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2.70 \u0026plusmn; 0.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e2.941\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 \u0026ndash; 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e2 \u0026ndash; 3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eINR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eMean \u0026plusmn; SD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.24 \u0026plusmn; 0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1.42 \u0026plusmn; 0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-2.813\u0026bull;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 15px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.04 \u0026ndash; 1.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1 \u0026ndash; 2.21\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eP-value \u0026gt; 0.05: Not significant (NS); P-value \u0026lt; 0.05: Significant (S); P-value \u0026lt; 0.01: Highly significant (HS) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*: Chi-square test\u0026emsp;\u0026bull;: Independent t-test\u0026emsp;\u0026ne;: Mann\u0026ndash;Whitney U test\u003c/p\u003e\n\u003cp\u003eThere were no statistically significant differences between patients with and without esophageal varices in terms of WBC count (\u003cem\u003ep\u003c/em\u003e = 0.767), hemoglobin (\u003cem\u003ep\u003c/em\u003e = 0.259), blood urea nitrogen (\u003cem\u003ep\u003c/em\u003e = 0.953), creatinine (\u003cem\u003ep\u003c/em\u003e = 0.169), sodium (\u003cem\u003ep\u003c/em\u003e = 0.460), potassium (\u003cem\u003ep\u003c/em\u003e = 0.789), total bilirubin (\u003cem\u003ep\u003c/em\u003e = 0.611), direct bilirubin (\u003cem\u003ep\u003c/em\u003e = 0.812), AST (\u003cem\u003ep\u003c/em\u003e = 0.812), or ALT (\u003cem\u003ep\u003c/em\u003e = 1.000). These results were evaluated using independent \u003cem\u003et\u003c/em\u003e-tests (\u0026bull;) and Mann\u0026ndash;Whitney U tests (\u0026ne;), depending on data distribution.However, significant differences were noted in platelet count (\u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001), serum albumin (\u003cem\u003ep\u003c/em\u003e = 0.005), and INR (\u003cem\u003ep\u003c/em\u003e = 0.007). Patients with varices exhibited marked thrombocytopenia, hypoalbuminemia, and elevated INR levels, highlighting impaired synthetic liver function and portal hypertension among this group.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Comparison of Imaging Features and Ascites Severity\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 32px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo varices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVarices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eHBsAg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26 (92.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e32 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e2.365*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eHCV Ab\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e0.019*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e26 (92.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e30 (93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eAFP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e1.88 (1.35 \u0026ndash; 5.15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e3.6 (1.63 \u0026ndash; 22.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e-0.830\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e0.9 \u0026ndash; 25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e0.7 \u0026ndash; 23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003ePVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e28 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e32 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eHFL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e28 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e32 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 5px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 16px;\"\u003e\n \u003cp\u003eSplenomegaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e8 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e2 (6.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 12px;\"\u003e\n \u003cp\u003e5.357*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e20 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e30 (93.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"4\" style=\"width: 16px;\"\u003e\n \u003cp\u003eAscites\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e4 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 12px;\"\u003e\n \u003cp\u003e3.750*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 9px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eModerate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e14 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e14 (43.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e6 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e6 (18.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 16px;\"\u003e\n \u003cp\u003eMarked\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 20px;\"\u003e\n \u003cp\u003e2 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 18px;\"\u003e\n \u003cp\u003e8 (25.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eP-value \u0026gt; 0.05: Not significant (NS); P-value \u0026lt; 0.05: Significant (S); P-value \u0026lt; 0.01: Highly significant (HS) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*: Chi-square test\u0026emsp;\u0026bull;: Independent t-test\u0026emsp;\u0026ne;: Mann\u0026ndash;Whitney U test\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference between patients with and without esophageal varices in terms of hepatitis B surface antigen (HBsAg, \u003cem\u003ep\u003c/em\u003e = 0.124), hepatitis C antibody (HCV Ab, \u003cem\u003ep\u003c/em\u003e = 0.890), alpha-fetoprotein levels (AFP, \u003cem\u003ep\u003c/em\u003e = 0.406), portal vein thrombosis (PVT, \u003cem\u003ep\u003c/em\u003e = 0.110), or ascites severity (\u003cem\u003ep\u003c/em\u003e = 0.290). These parameters were assessed using chi-square (*) and Mann\u0026ndash;Whitney U (\u0026ne;) tests, with all \u003cem\u003ep\u003c/em\u003e-values exceeding the threshold of significance. In contrast, splenomegaly was significantly more prevalent among patients with varices (93.8%) compared to those without (71.4%, \u003cem\u003ep\u003c/em\u003e = 0.021), suggesting a strong association between spleen enlargement and portal hypertension\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8. Biomarker Differences Including PLT, VWF, and VITRO Score\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"102%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\" rowspan=\"2\" style=\"width: 31px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo varices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVarices\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTest value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSig.\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 28\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo. = 32\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 13px;\"\u003e\n \u003cp\u003eChild grade\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e6 (21.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e4 (12.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 11px;\"\u003e\n \u003cp\u003e1.071*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.585\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e14 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e16 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e8 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e12 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eChild Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e7.5 (7 \u0026ndash; 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e9 (7.5 \u0026ndash; 10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-1.956\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e6 \u0026ndash; 11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e6 \u0026ndash; 14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eMELD Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e13 (10 \u0026ndash; 16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e13.5 (9 \u0026ndash; 22)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-0.684\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eNS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e7 \u0026ndash; 26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e8 \u0026ndash; 29\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e152.5 (107 \u0026ndash; 216)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e65.5 (58.5 \u0026ndash; 91.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-4.746\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e58 \u0026ndash; 342\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e31 \u0026ndash; 145\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eVWF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e29.52 (26.84 \u0026ndash; 46.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e81.95 (75.61 \u0026ndash; 96.28)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-5.516\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e17.14 \u0026ndash; 86.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e45.61 \u0026ndash; 112.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 13px;\"\u003e\n \u003cp\u003eVITRO score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.23 (0.15 \u0026ndash; 0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e1.22 (1.03 \u0026ndash; 1.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 11px;\"\u003e\n \u003cp\u003e-6.582\u0026ne;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 5px;\"\u003e\n \u003cp\u003eHS\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003eRange\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.08 \u0026ndash; 0.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 21px;\"\u003e\n \u003cp\u003e0.78 \u0026ndash; 1.92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eP-value \u0026gt; 0.05: Not significant (NS); P-value \u0026lt; 0.05: Significant (S); P-value \u0026lt; 0.01: Highly significant (HS) \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e*: Chi-square test\u0026emsp;\u0026bull;: Independent t-test\u0026emsp;\u0026ne;: Mann\u0026ndash;Whitney U test\u003c/p\u003e\n\u003cp\u003ePatients with esophageal varices demonstrated statistically significant differences in liver disease severity metrics. Child-Pugh grades and scores showed notable distribution shifts between the groups, though the difference approached but did not reach conventional levels of significance (p = 0.051). MELD scores also showed no significant variation. In contrast, platelet count, von Willebrand factor (VWF), and VITRO score were markedly altered in varices patients\u0026mdash;indicating advanced portal hypertension. Specifically, platelet levels were significantly lower, while both VWF and VITRO scores were significantly elevated in the varices group (p \u0026lt; 0.001 for all comparisons, Mann\u0026ndash;Whitney U test \u0026ne;). These findings underscore the diagnostic relevance of these biomarkers in predicting variceal presence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 9. Correlation Between VITRO Score and Clinical Parameters\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 40px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 59px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVITRO score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e-0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.330\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eWBCs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e-0.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.091\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eHb\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e-0.230\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.076\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eBUN\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eCreat.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e-0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eNa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.179\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eK\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.696\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eTotal bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.622\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eDirect bilirubin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e-0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.946\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eAST\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.120\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.359\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eALT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.350\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eAlbumin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.316*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.014\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eINR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.478**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eAFP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eChild Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.282*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eMELD Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e0.125\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003ePLT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-0.829**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 40px;\"\u003e\n \u003cp\u003eVWF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.596**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 30px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eSpearman correlation analysis revealed no statistically significant associations between the VITRO score and age, WBC count, hemoglobin, BUN, creatinine, sodium, potassium, total and direct bilirubin, AST, ALT, AFP, or MELD score (p \u0026gt; 0.05). In contrast, significant correlations were observed with serum albumin (r = \u0026ndash;0.316, p = 0.014), INR (r = 0.478, p \u0026lt; 0.001), Child score (r = 0.282, p = 0.029), platelet count (r = \u0026ndash;0.829, p \u0026lt; 0.001), and VWF (r = 0.596, p \u0026lt; 0.001). Elevated VITRO scores were associated with hypoalbuminemia, thrombocytopenia, increased INR, and higher Child scores\u0026mdash;supporting its utility in assessing disease severity and variceal risk.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 10. Logistic Regression Analysis Predicting Presence of Esophageal Varices\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"100%\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"3\" style=\"width: 14px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"4\" style=\"width: 42px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMultivariate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003cbr\u003e\u0026nbsp;(OR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% C.I. for OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u0026nbsp;\u003cbr\u003e\u0026nbsp;(OR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 17px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% C.I. for OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLower\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUpper\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003ePlatelets \u0026le; 93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e42.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e9.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e186.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eINR \u0026gt;1.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e6.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e1.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e21.262\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eSplenomegaly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.033\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e6.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e1.153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e31.228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 14px;\"\u003e\n \u003cp\u003eVWF \u0026gt;56.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e42.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e9.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e186.226\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 8px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 17px;\"\u003e\n \u003cp\u003e42.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7px;\"\u003e\n \u003cp\u003e9.472\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9px;\"\u003e\n \u003cp\u003e186.226\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eLogistic regression analysis identified significant associations between esophageal varices and platelet count, INR, splenomegaly, and von Willebrand factor (VWF) levels (p \u0026lt; 0.05 for all). Among these, elevated VWF emerged as the strongest independent predictor of variceal presence (OR = 42.00, 95% CI: 9.472\u0026ndash;186.226, p \u0026lt; 0.001). Furthermore, the VITRO score demonstrated perfect specificity (100%) in discriminating patients with varices, underscoring its potential as a non-invasive diagnostic tool.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"VITRO Score, von Willebrand Factor, Thrombocyte Ratio, Esophageal Varices, Portal Hypertension, Liver Cirrhosis","lastPublishedDoi":"10.21203/rs.3.rs-7124577/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7124577/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eBleeding from esophageal varices is a leading cause of mortality in patients with liver cirrhosis. These varices reflect the presence of clinically significant portal hypertension (CSPH), defined as a portal pressure gradient exceeding 10 mmHg. Currently, the gold standard diagnostic tools\u0026mdash;hepatic venous pressure gradient (HVPG) measurement and upper gastrointestinal endoscopy (UGIE)\u0026mdash;are invasive, costly, and not routinely accessible.\u003c/p\u003e\u003ch2\u003eAim\u003c/h2\u003e\u003cp\u003eTo evaluate the VITRO score (von Willebrand factor antigen/platelet count ratio) as a non-invasive marker for the presence of esophageal varices in patients with CSPH.\u003c/p\u003e\u003ch2\u003ePatients and Methods:\u003c/h2\u003e\u003cp\u003eSixty Egyptian cirrhotic patients were recruited and classified into two groups\u0026mdash;those with and without esophageal varices\u0026mdash;based on UGIE findings. All participants underwent comprehensive clinical evaluation, hematological and biochemical laboratory testing, and serum von Willebrand factor antigen (VWF) quantification.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe VITRO score was significantly higher in patients with esophageal varices (median 1.22, IQR: 1.03\u0026ndash;1.32) compared to those without (median 0.23, IQR: 0.15\u0026ndash;0.40), (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). VITRO values ranged from 0.78 to 1.92 in the varices group, and from 0.08 to 0.82 in the non-varices group. No significant correlations were observed between the VITRO score and age, WBC count, hemoglobin, renal function, electrolytes, liver enzymes, AFP, or MELD score. ROC analysis revealed a cutoff value of \u0026gt;\u0026thinsp;0.82 with a sensitivity of 93.75% and specificity of 100% for detecting esophageal varices.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe VITRO score is a promising non-invasive biomarker for identifying esophageal varices in patients with clinically significant portal hypertension, offering potential to reduce reliance on invasive procedures.\u003c/p\u003e","manuscriptTitle":"Evaluation of the VITRO Score as a Non-Invasive Marker for Esophageal Varices in Liver Cirrhosis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-28 11:07:48","doi":"10.21203/rs.3.rs-7124577/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"adcbb752-d53d-41d5-bf86-bf8e3ea5b377","owner":[],"postedDate":"July 28th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-15T09:23:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-28 11:07:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7124577","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7124577","identity":"rs-7124577","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}