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.
Highlights
All patients with liver cirrhosis are recommended to undergo an evaluation of esophageal varices (EV) to assess their risk of bleeding
The following information was collected for each patient: age, gender, biochemical parameters including aspartate aminotransferase (AST), alanine aminotransferase (ALT), ALT/AST ratio, total bilirubin, conjugated bilirubin, total protein, serum albumin, prothrombin time, prothrombin activity (%), alkaline phosphatase, γ-glutamyl transpeptidase (GT), platelet count, presence and degree of ascites and encephalopathy assessed according to Child-Pugh criteria [5]
The results of the present study indicate that the portal vein diameter with an area under receiver operating characteristic curve (AUROC) of 0.739 could be a valuable predictor of EV in patients with HBV-related cirrhosis
Summary
All 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 noninvasive 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. Most cirrhotic patients develop esophageal varices, with a lifetime incidence as high as 90% [1]. One third of cirrhotic patients with esophageal varices (EV) develop an episode of esophageal hemorrhage, and subsequently have high morbidity and mortality [1]. Screening all patients with endoscopy to guide therapy may significantly increase the cost. Mally protrude into the esophageal lumen, while large EV were defined as varices that protrude into the esophageal lumen and touch each other (presence of confluence), or that fill at least 50% of the esophageal lumen.
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