Non-invasive predictors of esophageal varices

Cherian, Jijo Velliyappillil; Deepak, N; Ponnusamy, Rajesh Prabhu; Arumugam, Somasundaram; Venkataraman, Jayanthi

doi:10.4103/1319-3767.74470

Cited by 59 publications

(31 citation statements)

References 19 publications

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“…Up to now, endoscopy has still been the gold standard modality to identifying esophageal varices [ 1 ]. However many studies attempt to identify noninvasive factors predicting the presence and the grade of esophageal varices [ 2 , 3 ]. Several Studies have shown that multiple parameters can be a predictors for the presence of oesophageal varices like splenomegaly, [ 4 – 6 ] ascites [ 4 ], spider naevi [ 7 ], Child's grade [ 6 , 7 ], platelet count [ 7 – 10 ], prothrombin time/activity [ 8 ], portal vein diameter [ 11 ], platelet count/ spleen diameter ratio [ 11 , 12 ], serum albumin [ 12 ], and serum bilirubin [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

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Noninvasive predictors of presence and grade of esophageal varices in viral cirrhotic patients

Lahmidani¹,

Samira²,

Bahija³

et al. 2015

Pan Afr Med J

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Predicting the presence and the grade of varices by non-invasive methods is likely to predict the need for prophylactic beta blockers or endoscopic variceal ligation. The factors related to the presence of varices are not well-defined. Therefore, the present study has been undertaken to determine the appropriateness of the various factors in predicting the existence and also the grade of esophageal varices. Patients with diagnosis of liver cirrhosis due to hepatitis C or B were included in a retrospective study between January 2001 and January 2010. All the patients underwent detailed clinical evaluation, appropriate investigations, imaging studies (ultrasound with Doppler) and endoscopy at our center. Five variables considered relevant to the presence and grade of varices were tested using univariate and multivariate analysis (logistic regression). Three hundred and seventy two patients with viral liver cirrhosis were included, with 192 (51.6%) males. Platelet count and abundance of ascites were significantly associated with the presence of esophageal varices. However, abundance of ascites, prothrombin time, diameter of the spleen and portal vein were significantly associated with a large varice. In multivariate analysis, platelet count inferior to 100000 was associated with presence of varices (p = 0.04) and only abundance of ascites was associated with large varice. Low Platelet count (< or equal 100000) is associated with the presence of varices in viral cirrhotic patients and abundance of ascites is correlated with the presence of large varices.

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Section: Discussionmentioning

confidence: 99%

“…This factor was also significant on multivariate analysis. Several studies suggest that platelet count may predict the presence of EV in patients with cirrhosis [ 2 , 8 , 9 ]. However, the discriminating threshold for the presence of varices varies widely, ranging between 68,000 and 160,000/mm 3 [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Noninvasive predictors of presence and grade of esophageal varices in viral cirrhotic patients

Lahmidani¹,

Samira²,

Bahija³

et al. 2015

Pan Afr Med J

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“…Univariate logistic regression followed by a multivariate logistic regression model was employed to calculate the odds ratio (OR) at 95% confidence interval (CI) to assess the degree of association between different factors and the presence of esophageal varices. On the basis of previous literatures [12, 13, 17–20], and our own clinical experience we selected age, sex, alcohol use, jaundice, ascites, hepatitis status, platelet counts (PTC), hemoglobin level, serum albumin, portal vein diameter (PVD), splenic diameter (SPD), and Child-Pugh score as potential predictors of esophageal varices. Parameters including hepatic encephalopathy, serum bilirubin, serum albumin, ascites and international normalized ratio (INR) were used to calculate the Child-Pugh score as done previously [21].…”

Section: Methodsmentioning

confidence: 99%

The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

et al. 2019

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BackgroundBleeding esophageal varices is a deadly complication of liver cirrhosis. Guidelines recommend an early diagnosis of esophageal varices before incident bleeding by screening all patients diagnosed with liver cirrhosis. Though it has been reported elsewhere that the presence of esophageal varices varies widely among cirrhotic patients this has not been assessed in Tanzania since endoscopy is not readily available for routine use in our setting. This study was designed to determine the prevalence of esophageal varices and assess the utility of clinical parameters in predicting the presence of varices among cirrhotic patients in northwestern Tanzania.MethodsA cross-sectional analysis of adult patients with liver cirrhosis was done at Bugando Medical Centre. Demographic, clinical, laboratory and endoscopic data were collected and analyzed using STATA 13. The presence of esophageal varices was detected using endoscopic examination and associated factors were assessed by logistic regression. The predictive value of clinical predictors was also assessed by calculating sensitivity and specificity.ResultsA total of 223 patients were enrolled, where 88 (39.5%; 95%CI: 33.0–45.9) had esophageal varices. The varices were independently associated with increased age (OR: 1.02; 95%CI: 1.0–1.04; p = 0.030); increased splenic diameter (OR:1.3; 95%CI:1.2–1.5; p < 0.001), increased portal vein diameter (OR:1.2; 95%CI: 1.07–1.4; p = 0.003), having ascites (OR: 3.0; 95%CI: 1.01–8.7; p = 0.046), and advanced liver disease (OR: 2.9; 95%CI: 1.3–6.7; p = 0.008). PSDR least performed in predicting varices, (AUC: 0.382; 95%CI: 0.304–0.459; cutoff: < 640; Sensitivity: 58.0%; 95%CI: 46.9–68.4; specificity: 57.0%; 95%CI: 48.2–65.5). SPD had better prediction; (AUC: 0.713; 95%CI: 0.646–0.781; cut off: > 15.2 cm; sensitivity: 65.9%; (95% CI: 55–75.7 and specificity:65.2%; 95%CI: 56.5–73.2), followed by PVD, (AUC: 0.6392; 95%CI: 0.566–0.712;cutoff: > 1.45 cm; sensitivity: 62.5%; 95CI: 51.5–72.6; specificity: 61.5%; 95%CI: 52.7–69.7).ConclusionEsophageal varices were prevalent among cirrhotic patients, most of which were at risk of bleeding. The non-invasive prediction of varices was not strong enough to replace endoscopic diagnosis. However, the predictors in this study can potentially assist in the selection of patients at high risk of having varices and prioritize them for endoscopic screening and appropriate management.

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“… 64 67 Other blood tests that were determined to predict varices were platelet count (sensitivity 56-76%; specificity 64-88%) and AST-to-platelet Index (sensitivity 59-86%; specificity 64-81%). 62 64 68 69 70 Among the doppler ultrasound parameters only hepatic artery resistive index was found to be associated with presence of varices. 55 57 …”

Section: Varicesmentioning

confidence: 95%

Personalized management of cirrhosis by non-invasive tests of liver fibrosis

2015

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Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted.

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Non-invasive predictors of esophageal varices

Cited by 59 publications

References 19 publications

Noninvasive predictors of presence and grade of esophageal varices in viral cirrhotic patients

Noninvasive predictors of presence and grade of esophageal varices in viral cirrhotic patients

The magnitude and correlates of esophageal Varices among newly diagnosed cirrhotic patients undergoing screening fibre optic endoscope before incident bleeding in North-Western Tanzania; a cross-sectional study

Personalized management of cirrhosis by non-invasive tests of liver fibrosis

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