Universal Index for Cirrhosis (UIC index): The development and validation of a novel index to predict advanced liver disease

Figures & data

Table 1 Profile of all patients

Items	Frequency	%
Gender
Male	299	50.8
Etiology
Hepatitis C	253	42.9
Non-alcoholic fatty liver disease	160	27.2
Alcoholic liver disease	30	5.1
Hepatitis B	14	2.4
Other liver diseases	132	22.4
Race/ethnicity
White American	466	79.1
Black American	89	15.1
Others	34	5.8
Alcohol use (yes)	212	36.0
Tobacco use
Yes, currently use	222	37.7
Already quit	188	29.7
Never use	179	32.6
Fibrosis stage
Stage 0	86	14.6
Stage 1	84	14.3
Stage 2	181	30.7
Stage 3	69	11.7
Stage 4	169	28.7
Age (year), mean ± SD	53.4±11.8

Table 2 Univariate logistic regression in the training set

Variables	No cirrhosis n=223	Cirrhosis n=71	P-value
Age, years	52.52±12.16	55.91±11.06	0.059
Male gender, n (%)	116 (52.0)	29 (40.9)	0.102
Ethnicity, n (%)
Black American/others	56 (25.1)	11 (15.5)	0.096
White American	167 (74.9)	60 (84.5)	Ref.
Alcohol use, n (%)	81 (36.3)	20 (28.2)	0.209
Tobacco use, n (%)
Currently use	94 (42.2)	24 (33.8)	0.488
Already quit	64 (28.7)	26 (36.6)	0.503
Never use	65 (29.1)	21 (29.6)	Ref.
Body mass index	29.62±7.49	30.47±7.29	0.182
Routine biomarkers
SGOT(U/L)a	4.09±0.77	4.3±0.62	0.082
SGPT(U/L)a	4.19±0.79	4.08±0.72	0.149
BUN (mg/dL)a	2.65±0.44	2.63±0.48	0.236
Platelet count (10^9/L)	220.07±75.81	149.1±68.93	<0.001
TP (g/dL)	7.2±0.89	7.16±0.91	0.996
INR	1.07±0.25	1.24±0.32	<0.001
ALK (U/L)a	4.74±0.53	4.83±0.4	0.261
Bilirubin (mg/dL)a	–0.37±0.85	0.2±0.96	<0.001
Albumin (g/dL)	3.91±0.62	3.47±0.74	<0.001
Creatinine (mg/dL)a	–0.15±0.41	–0.13±0.45	0.718
Glucose (mg/dL)a	4.67±0.3	4.73±0.32	0.460
Created variables
SGOT_SGPTb	0.98±0.11	1.07±0.14	<0.001
INR_Albuminc	0.29±0.14	0.39±0.19	<0.001
BUN_Glucosed	0.57±0.09	0.55±0.09	0.091

Notes:

a On logarithmic transformation scale.

b SGOT_SGPT = log(SGOT)/log(SGPT).

c INR_Albumin = INR/Albumin.

d BUN_Glucose = log(BUN)/log(Glucose).

Abbreviation: BUN, blood urea nitrogen; INR, international normalized ratio; SGOT, serum glutamic-oxaloacetic acid transaminase; SGPT, serum glutamic-pyruvic transaminase.

Figure 1 ROC curve of UIC_index.

Abbreviations: ROC, receiver operating characteristic; UIC, Universal Index for Cirrhosis.

Table 3 Comparing the UIC_index of cirrhosis with other existing indices

	Index	Training set		Validation set
		AUROC	95% CI	AUROC	95% CI
Any	Fibro-Q	0.79	0.72–0.85	0.82	0.76–0.87
etiology	FIB4	0.77a	0.71–0.84	0.82	0.77–0.87
	APRI	0.71a	0.64–0.78	0.77	0.72–0.83
	AAR	0.73a	0.66–0.80	0.72a	0.66–0.78
	UICindex	0.82	0.75–0.87	0.83	0.77–0.88
HCV only	Fibro-Q	0.79	0.68–0.90	0.84	0.76–0.92
	FIB4	0.82	0.72–0.92	0.87	0.79–0.94
	APRI	0.77	0.65–0.88	0.86	0.78–0.93
	AAR	0.66a	0.52–0.80	0.67a	0.56–0.79
	UICindex	0.87	0.78–0.94	0.84	0.75–0.92

Note:

a Significant difference (P<0.05) compared to UIC_index.

Abbreviations: AUROC, area under the receiver operating characteristic; HCV, hepatitis C virus; UIC, Universal Index for Cirrhosis.

Table 4 Accuracy of the UIC_index in predicting cirrhosis

UICindex	All patients n (%)	No cirrhosis (stage 0–3) n (%)	Cirrhosis (stage 4) n (%)	NPV %	PPV %	Sensitivity %	Positive and negative likelihood ratio
Training set
<4.5	75 (20)	72 (25)	3 (4)	96.0	26.8	96.4	3.9
≥4.5	302 (80)	221 (75)	81 (96)
<8.0	177 (47)	164 (56)	13 (15)	92.7	35.5	84.5	1.5
≥8.0	200 (53)	129 (44)	71 (85)
<20.0	321 (85)	271 (92)	50 (60)	84.4	60.7	40.5	0.4
≥20.0	56 (15)	22 (8)	34 (40)
Validation set
<4.5	63 (16)	60 (22)	3 (3)	95.2	34.7	97.5	4.5
≥4.5	331 (84)	216 (78)	115 (97)
<8.0	173 (44)	158 (57)	15 (13)	91.3	46.6	87.3	1.5
≥8.0	221 (56)	118 (43)	103 (87)
<20.0	319 (81)	254 (92)	65 (55)	79.6	70.7	44.9	0.5
≥20.0	75 (19)	22 (8)	53 (45)

Abbreviations: PPV, positive predictive value; NPV, negative predictive value; UIC, Universal Index for Cirrhosis.