A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease
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Background/Aims: The aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters. Methods: We retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography. Results: The multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm3)×albumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confi dence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%. Conclusions: The VAP score can predict the presence of varices and PHG in patients with CLD and may increase the costbenefi t of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future. (Clin Mol Hepatol 2012;18:178-184)
Abstract
Background/Aims: The aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters. Methods: We retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography. Results: The multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm3)×albumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confi dence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%. Conclusions: The VAP score can predict the presence of varices and PHG in patients with CLD and may increase the costbenefi t of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future. (Clin Mol Hepatol 2012;18:178-184)
참고문헌 (24)
- de Franchis R, "Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension", J Hepatol, 43, pp.167~176 (2005)
- North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices, "Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study", N Engl J Med, 319, pp.983~989 (1988)
- Smith JL, "Variceal hemorrhage: a critical evaluation of survival analysis", Gastroenterology, 82, pp.968~973 (1982)
- Merli M, "The natural history of portal hypertensive gastropathy in patients with liver cirrhosis and mild portal hypertension", Am J Gastroenterol, 99, pp.1959~1965 (2004)
- Thuluvath PJ, "Portal Hypertensive gastropathy", Am J Gastroenterol, 97, pp.2973~2978 (2002)
- Fontana RJ, "Portal hypertensive gastropathy in chronic hepatitis C patients with bridging fibrosis and compensated cirrhosis: results from the HALT-C trial", Am J Gastroenterol, 101, pp.983~992 (2006)
- Jensen DM, "Endoscopic screening for varices in cirrhosis: findings, implications, and outcomes", Gastroenterology, 122, pp.1620~1630 (2002)
- Ng FH, "Prediction of oesophagogastric varices in patients with liver cirrhosis", J Gastroenterol Hepatol, 14, pp.785~790 (1999)
- Pilette C, "Non-invasive diagnosis of esophageal varices in chronic liver diseases", J Hepatol, 31, pp.867~873 (1999)
- Chalasani N, "Predictors of large esophageal varices in patients with cirrhosis", Am J Gastroenterol, 94, pp.3285~3291 (1999)
- Madhotra R, "Prediction of esophageal varices in patients with cirrhosis", J Clin Gastroenterol, 34, pp.81~85 (2002)
- Thomopoulos KC, "Non-invasive predictors of the presence of large oesophageal varices in patients with cirrhosis", Dig Liver Dis, 35, pp.473~478 (2003)
- Schepis F, "Which patients with cirrhosis should undergo endoscopic screening for esophageal varices detection?", Hepatology, 33, pp.333~338 (2001)
- Zaman A, "Risk factors for the presence of varices in cirrhotic patients without a history of variceal hemorrhage", Arch Intern Med, 161, pp.2564~2570 (2001)
- Zein CO, "Prevalence and predictors of esophageal varices in patients with primary sclerosing cholangitis", Hepatology, 39, pp.204~210 (2004)
- Bezerra AS, "Determination of splenomegaly by CT: is there a place for a single measurement?", AJR Am J Roentgenol, 184, pp.1510~1513 (2005)
- Japanese Research Society for Portal Hypertension, "The general rules for recording endoscopic findings on esophageal varices", Jpn J Surg, 10, pp.84~87 (1980)
- Beppu K, "Prediction of variceal hemorrhage by esophageal endoscopy", Gastrointest Endosc, 27, pp.213~218 (1981)
- Spina GP, "Gastric endoscopic features in portal hypertension: final report of a consensus conference, Milan, Italy, September 19, 1992", J Hepatol, 21, pp.461~467 (1994)
- Giannini EG, "Platelet count", spleen diameter ratio for the noninvasive diagnosis of esophageal varices: results of a multicenter, prospective, validation study, 2006, pp.101, 2511~2519
- Giannini E, "Platelet count", spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis, 2003, pp.52, 1200~1205
- Sarin SK, "Prevalence, classification and natural history of gastric varices: a longterm follow-up study in 568 portal hypertension patients", Hepatology, 16, pp.1343~1349 (1992)
- Garcia-Tsao G, "Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis", Hepatology, 46, pp.922~938 (2007)
- Ryan BM, "A pathophysiologic, gastroenterologic, and radiologic approach to the management of gastric varices", Gastroenterology, 126, pp.1175~1189 (2004)