Predictors of esophageal varices in patients with HBV-related cirrhosis: a retrospective study

Abstract

BackgroundAll patients with liver cirrhosis are recommended to undergo an evaluation of esophageal varices (EV) to assess their risk of bleeding. Predicting the presence of EV through non-invasive means may reduce a large number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Hepatitis B virus-related cirrhosis.MethodsThe retrospective analysis was performed in 146 patients with Hepatitis B virus-related cirrhosis. The data were assessed by univariate analysis and a multivariate logistic regression analysis. In addition, the receiver operating characteristic curves were also applied to calculate and compare the accuracy of the model and other single parameters for the diagnosis of esophageal varices.ResultsWe found the prevalence of EV in patients with Hepatitis B virus-related cirrhosis to be 74.7%. In addition, platelet count, spleen width, portal vein diameter and platelet count/spleen width ratio were significantly associated with the presence of esophageal varices on univariate analysis. A multivariate analysis revealed that only the spleen width and portal vein diameter were independent risk factors. The area under the receiver operating characteristic curve of regression function (RF) model, which was composed of the spleen width and portal vein diameter, was higher than that of the platelet count. With a cut-off value of 0.3631, the RF model had an excellent sensitivity of 87.2% and an acceptable specificity of 59.5% with an overall accuracy of 80.1%.ConclusionOur data suggest that portal vein diameter and spleen width rather than platelet count may predict the presence of varices in patients with Hepatitis B virus-related cirrhosis, and that the RF model may help physicians to identify patients who would most likely benefit from screenings for EV.

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

“…This finding corroborates with those reported by Hong et al who examined these predictors in Hepatitis B related cirrhosis. 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.…”

Noninvasive prediction of large esophageal varices in liver cirrhosis patients

“…Tested in our study group, the predictive models of Hong et al [13], Giannini et al [16], and our proposed model yielded obviously higher AUROC (>0.7), while the AUROC from other four models was less than 0.7. Even though there was no signi cant di erence from the predictive models of Hong et al [13] and Giannini et al [16], our NIP model achieves the highest AUROC value (Table 6), thus representing the best predictive model for prediction of large sized esophageal varices in our liver cirrhosis patients. Among the tested seven predictive models, as well as other individual and compound variables, our proposed predictive model had the greatest diagnostic ability in predicting large esophageal varices.…”

“…Large esophageal varices appeared to have a lower platelet count and hemoglobin level but higher γ-GT activity, portal vein and spleen diameters. Since some compound variables (a combination of two di erent variables) are frequently used in predictive models as previously reported [13][14][15][16], here, an additional six compound variables were evaluated (Table 3). e presence of large esophageal varices was signi cantly associated with lower ratios of platelet count/ spleen diameter, right liver lobe/albumin and platelet count/ portal vein diameter.…”

Non-invasive parameters for the detection of variceal bleed in patients of liver cirrhosis, an experience of a tertiary care hospital in Pakistan

“…3,4,5 Gastro esophageal varices are present in approximately 50% of patients with cirrhosis with a lifetime incidence of 90%. Their presence also correlate with the severity of disease, being more common in Child Pugh Class C patients as compared to Child Pugh Class A patients (85% versus 40%) 6,7,8 ( Table 1). Variceal hemorrhage is a medical emergency.…”