Prediction of esophageal varices in hepatic cirrhosis by noninvasive markers

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dc.contributor.authorTafarel, Jean Rodrigo [UNIFESP]
dc.contributor.authorLenz Tolentino, Luciano Henrique [UNIFESP]
dc.contributor.authorCorrea, Lucianna Motta [UNIFESP]
dc.contributor.authorBonilha, Danielle Rossana [UNIFESP]
dc.contributor.authorPiauilino, Patricia [UNIFESP]
dc.contributor.authorMartins, Fernanda Prata [UNIFESP]
dc.contributor.authorRodrigues, Rodrigo Azevedo [UNIFESP]
dc.contributor.authorNakao, Frank Shigeo [UNIFESP]
dc.contributor.authorDella Libera, Ermelindo [UNIFESP]
dc.contributor.authorFerrari, Angelo Paulo [UNIFESP]
dc.contributor.authorSilveira Roehr, Maria Rachel da [UNIFESP]
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:17:11Z
dc.date.available2016-01-24T14:17:11Z
dc.date.issued2011-09-01
dc.description.abstractObjective To determine whether Model for End-stage Liver Disease (MELD) Child-Turcotte-Pugh (CTP) classification, AST to platelet ratio index (APRI), and laboratory tests could predict the presence of esophageal varices (EV) or varices which need prophylactic therapy (medium or large size EV).Methods Three hundred patients with cirrhosis (193 men; mean age 53.1 years; majority with chronic C hepatitis) were prospectively analyzed. the presence of EV (any size and medium or large EV) was correlated with patients' characteristics (MELD, CTP classification, APRI, platelets count, and liver tests).Results One hundred and seventy-one patients (57%) had EV, of whom 35% (105) had varices which need prophylactic therapy (VPT). the distribution of EV according to CTP classification was as follows: A, 49%; B, 75.3% and C, 80%. Independent predictors of EV were: MELD higher than 8 (P = 0.02); APRI higher than 1.64 (P = 0.01); platelet count lower than 93 000/mm(3) (P < 0.01); aspartate aminotransferase higher than 1.34 x UNL (P = 0.01), and total bilirubin higher than 1 mg/dl (P = 0.04). MELD higher than 8 had the highest discriminative value for presence of EV (sensitivity = 80.1%; specificity = 51.2%; area under receiver operating characteristics = 0.68). Factors independently associated with VPT were: thrombocytopenia (< 92 000/mm(3); P < 0.01) and aspartate aminotransferase higher than 1.47 x UNL (P = 0.03). Platelet count lower than 92 000/mm(3) had sensitivity of 65.7%, specificity of 57.9%, and an area under receiver operating characteristics of 0.62 for the presence of VPT.Conclusion 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. Eur J Gastroenterol Hepatol 23: 754-758 (C) 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.en
dc.description.affiliationUniversidade Federal de São Paulo, Dept Med, Div Gastroenterol & Gastrointestinal Endoscopy, BR-2027 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo, Dept Med, Div Gastroenterol & Gastrointestinal Endoscopy, BR-2027 São Paulo, Brazil
dc.description.sourceWeb of Science
dc.format.extent754-758
dc.identifierhttp://dx.doi.org/10.1097/MEG.0b013e3283488a88
dc.identifier.citationEuropean Journal of Gastroenterology & Hepatology. Philadelphia: Lippincott Williams & Wilkins, v. 23, n. 9, p. 754-758, 2011.
dc.identifier.doi10.1097/MEG.0b013e3283488a88
dc.identifier.issn0954-691X
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/34026
dc.identifier.wosWOS:000293499700002
dc.language.isoeng
dc.publisherLippincott Williams & Wilkins
dc.relation.ispartofEuropean Journal of Gastroenterology & Hepatology
dc.rightsinfo:eu-repo/semantics/restrictedAccess
dc.subjectcirrhosisen
dc.subjectesophageal varicesen
dc.subjectMELDen
dc.subjectplateletsen
dc.titlePrediction of esophageal varices in hepatic cirrhosis by noninvasive markersen
dc.typeinfo:eu-repo/semantics/article
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