Derivation of a Clinical Prediction Rule for the Noninvasive Diagnosis of Varices in Children

Abstract

This clinical prediction rule is a simple noninvasive measure that may identify children at high risk for esophageal varices. A prospective validation study is in progress.

Diagnosing native liver fibrosis and esophageal varices using liver and spleen stiffness measurements in biliary atresia: a pilot study

“…The aspartate aminotransferase to platelet ratio index might also be able to diagnose the presence of esophageal varices in postsurgical biliary atresia patients, with reported areas under the curves of 0.87-0.88 [13,27]. Gana et al [17] developed the clinical prediction rule to predict esophageal varices, and reported an area under the curve of 0.93 from a study of 51 pediatric patients with liver disease or portal vein thrombosis, and the validation studies showed areas under the curves of 0.80 and 0.77 [28,29]. The varices prediction rule was developed more recently from a study of 195 biliary atresia infants as a novel predictor of significant varices at 6 months post-Kasai portoenterostomy (area under the curve = 0.75; sensitivity = 86%; specificity = 71%).…”

“…From the assessment of esophageal varices, eight patients with a history of treatment for esophageal varices and/ or splenectomy were excluded; one patient had a history of splenectomy, five patients had a history of treatment for esophageal varices and two patients had both histories. The noninvasive liver fibrosis/portal hypertension markers, namely, the aspartate aminotransferase to platelet ratio index [16], the clinical prediction rule [17] and the varices prediction rule [18], were calculated using the following formulas:…”

Can platelet count/spleen diameter ratio be used for cirrhotic children to predict esophageal varices?

“…There have been several studies identifying non-invasive variables that may predict the presence of EV in children[6,7,10]. The first study, in which the predictive risk factors were evaluated by Fagundes et al[6] in a pediatric group [median age at the time of first EGD was 6 years (age range, 0.7-17.6 years)], showed that children with cirrhosis and splenomegaly were nearly 15-fold more likely to have EV compared with children with cirrhosis but without splenomegaly.…”

“…To reduce the increasing burden on endoscopy units and prevent unnecessary harm to patients, researchers have attempted to identify parameters for non-invasive prediction of EV[9]. Several reports have identified non-invasive variables that may predict the presence of EV in childhood and have shown predictive factors for bleeding risk, such as hypoalbuminemia, the Child-Pugh score, an increased spleen diameter (SD), a low platelet count (PC), the PC-to-SD ratio, the clinical prediction rule, and the aspartate aminotransferase-to-platelet ratio index[6,7,10]. For this purpose, the PC-to-SD ratio was investigated to predict the presence of EV in adult patients with cirrhosis[11-14].…”

Cirrhosis in children and adolescents: An overview

“…In a study of 76 children with cirrhosis candidates for liver transplantation, gastric or duodenal ulcers were diagnosed in 8/21 (38%) of children with gastrointestinal bleeding [54] . Studies of noninvasive methods to identify high risk of esophageal varices in children with chronic liver disease found that splenomegaly and hypoalbuminemia [55] , as well as platelet counts, Z scores of spleen size and albumin levels, predicted the presence of varices in patients with cirrhosis [56] .…”