Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers

Tafarel, Jean Rodrigo; Lenz, Luciano; Correa, Lucianna Motta; Bonilha, Danielle Rossana; Piauilino, Patrícia; Martins, Fernanda P.; Rodrigues, Rodrigo Azevedo; Nakao, Frank Shigeo; Líbera, Ermelindo Della; Ferrari, Ângelo Paulo; Röhr, Maria Rachel da Silveira

doi:10.1097/meg.0b013e3283488a88

Cited by 47 publications

(29 citation statements)

References 16 publications

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“…Our study has shown a potential relationship between the MELD score and the presence of OV (Po0.01), a result that was consistent with a previous study reporting that high values of the MELD score were associated with OV [7]. However, as a result of the low sensitivity and specificity of their results, the authors suggested maintaining the recommendation of UGIE for all patients with cirrhosis.…”

Section: Discussionsupporting

confidence: 92%

“…In our study, low platelet count was a significant laboratory parameter differentiating between patients with and without OV (105 ± 34.19 vs. 211 ± 94.54). In their study, Tafarel et al [7] found thrombocytopenia less than 92 000/ mm 3 (sensitivity of 65.7%, specificity of 57.9%) to be associated with varices that require prophylactic therapy. Several studies have shown a relation between low platelet count and OV [10,11] whereas others have shown a relation between low platelet count and the presence of large varices [12,13].…”

Section: Discussionmentioning

confidence: 92%

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Predicting the presence of high-risk oesophageal varices using noninvasive parameters in Egyptian cirrhotic patients

Safwat¹,

Khayyal²,

Fattah³

2014

Egyptian Liver Journal

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BackgroundPortal hypertension commonly accompanies liver cirrhosis. Bleeding because of oesophageal varices (OV) is one of the most dreaded complications of cirrhosis because of its high mortality rate. Endoscopy is recommended for the screening of OV. Aim of the work We aimed to assess the value of a model for end-stage liver disease (MELD) and MELD-Na scores, platelet count, alanine aminotransferase, aspartate aminotransferase and spleen size as predictors of OV. Patients and methods A total of 100 patients with established liver cirrhosis (80 men, 20 women) were enrolled in the study. All patients were subjected to a full clinical assessment and routine laboratory investigations. Child-Turcotte-Pugh, MELD and MELD-Na scores were calculated for each patient. Upper gastrointestinal endoscopy was performed for all patients. ResultsThe means of both MELD and MELD-Na were significantly higher among patients with OV. MELD at least 11.5 and MELD-Na at least 14.5 were both sensitive and specific for the presence of OV. Also, the MELD score showed increasing values with increasing grades of OV (Po0.01). Multivariate regression analysis identified the following two predictors of the presence of OV: MELD score at least 11.5 and platelet count up to 142.5 ( Â 1000/mm 3 ). Conclusion MELD, MELD-Na, spleen size and low platelet count can be used independently as predictors of OV; also, MELD can predict high-risk varices. However, it cannot completely replace the need for endoscopy because of its low specificity and sensitivity.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 92%

Predicting the presence of high-risk oesophageal varices using noninvasive parameters in Egyptian cirrhotic patients

Safwat¹,

Khayyal²,

Fattah³

2014

Egyptian Liver Journal

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“…22 We found significant association between INR values and the size of varices, which is contradictory to some earlier studies. [23][24] Berzigotti et al found significant association between serum albumin and variceal size, but our study failed to establish any such assocation. 25 Various Indian researchers have also explored the utility of non-endoscopic parameters.…”

Section: Discussioncontrasting

confidence: 53%

Combination of non-endoscopic parameters as predictors of large esophageal varices

Tp¹,

Patil²,

Salkar³

2014

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“…Clinicians may also be using other noninvasive clinical tests (i.e., platelet count, aminotransferase-to-platelet ratio index, platelet count-to-spleen size ratio, or model for end-stage liver disease score) to determine which patients with cirrhosis are more likely to have EV. This approach is suboptimal as these clinical tests have been consistently shown to have poor sensitivity and specificity in identifying patients likely to have EV on screening [19–21]. While spleen stiffness and the combination of liver stiffness, spleen size, and platelet counts have shown improvements in the ability to identify patients with high-risk varices, they are not yet ready for use in routine clinical practice [19, 22].…”

Section: Discussionmentioning

confidence: 99%

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

et al. 2015

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Background and Aim The American Association for the Study of Liver Disease (AASLD) recommends screening for esophageal varices (EV) by esophagoduodenoscopy (EGD) in patients with cirrhosis to guide decisions regarding primary prophylaxis for EV hemorrhage. We aimed to identify patient and facility factors associated with EV screening in veterans with hepatitis C (HCV)-associated cirrhosis. Methods This was a population-based cohort study. Veterans with HCV and newly diagnosed cirrhosis between 1/1/2004 and 12/31/2005 and followed until 12/31/2011 were included. The primary outcome was receipt of EGD within 1 year of cirrhosis diagnosis. Patient- and facility-level factors associated with EV screening were determined. Results A total of 4230 patients with HCV cirrhosis were identified. During median follow-up of 6.1 years (IQR: 4.0–8.0), 21.5 % developed a decompensating event, and 38.3 % died. Fifty-four percent received an EGD, and 33.8 % had an EGD within guidelines. Median time from cirrhosis diagnosis to EGD was 72 days (IQR: 12–176). Factors independently associated with receipt of EV screening were a decompensation event (OR 1.16, CI 1.01–1.32) and gastroenterology/hepatology clinic access (OR 2.1, CI 1.73–2.46), whereas cardiovascular (OR 0.81, CI 0.69–0.95), mental health (OR 0.79, CI 0.68–0.91), and respiratory (OR 0.85, CI 0.72–0.99) comorbidities were associated with reduced likelihood of EV screening. Conclusion EV screening per AASLD guidelines occurs in only one-third of patients. This missed opportunity was strongly associated with access to gastroenterology/hepatology specialty care. Additionally, providers may be relying on clinical cues (i.e., decompensation) to prompt referral for endoscopy suggesting education to improve compliance with guidelines is needed.

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Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers

Abstract: High values on MELD are associated with EV and thrombocytopenia, with varices which need prophylactic therapy. As a result of their low sensitivity and specificity, it is suggested to maintain the recommendation of upper gastrointestinal endoscopy for all patients with cirhosis.

Cited by 47 publications

References 16 publications

Predicting the presence of high-risk oesophageal varices using noninvasive parameters in Egyptian cirrhotic patients

Predicting the presence of high-risk oesophageal varices using noninvasive parameters in Egyptian cirrhotic patients

Combination of non-endoscopic parameters as predictors of large esophageal varices

Facility- and Patient-Level Factors Associated with Esophageal Variceal Screening in the USA

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