Risk Factors for the Presence of Varices in Cirrhotic Patients Without a History of Variceal Hemorrhage

Zaman, Atif; Becker, Thomas; Lapidus, Jodi; Benner, Kent G.

doi:10.1001/archinte.161.21.2564

Cited by 157 publications

(128 citation statements)

References 32 publications

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“…It may be explained according to the issue that palpable spleen as well as LEV may both be related to the presence of a higher portal pressure. Different factors found to be important for this purpose included splenomegaly [23][24][25][26][27][28] , thrombocytopenia [23][24][25][26][27][28][29][30] , ascites [25,27] , hepatic encephalopathy [25] , serum albumin concentration [30] , serum bilirubin levels [30] , and Child-Pugh score [27,28] . Thus, the results of our study are consistent with those of the previously published data.…”

Section: Resultsmentioning

confidence: 99%

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Tarzamni¹,

Somi²,

Farhang³

et al. 2008

WJG

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AIM:To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS:A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible noninvasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni-and multivariate approaches. RESULTS:Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (± SD) was 47.5 (± 15.9). Portal vein diameter (13.88 ± 2.42 vs 12.00 ± 1.69, P < 0.0005) and liver vascular index (8.31 ± 2.72 vs 17.8 ± 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 ± 1.48 vs 13.24 ± 2.55, P < 0.05 and 6.45 ± 2.78 vs 10.96 ± 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 ± 3.66 vs 20.25 ± 5.05, P < 0.0005), congestion index (CI) (0.11 ± 0.03 vs 0.06 ± 0.03, P < 0.0005), portal hypertensive index (2.62 ± 0.79 vs 1.33 ± 0.53, P < 0.0005), and hepatic (0.73 ± 0.07 vs 0.66 ± 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 ± 0.06 vs 0.62 ± 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION:Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.

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Section: Resultsmentioning

confidence: 99%

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Tarzamni¹,

Somi²,

Farhang³

et al. 2008

WJG

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“…On the other hand, the presence of splenomegaly in cirrhotic patients is likely the result of vascular disturbance that are mainly linked to portal hypertension. 2,4 In our study, it was observed that mean platelet count in grade-I EV was 142568.42±6640.369/mm 3 3 . Platelet count showed a highly statistical significant inverse correlation with the grading of esophageal varices, which is in agreement with Thomopulos et al 5 Esophageal varices were graded according to Paquet 6 .…”

Section: Fig-2mentioning

confidence: 51%

Correlation of portal vein diameter, splenomegaly and thrombocytopenia with gastro-espohageal varices in cirrhotic patients

Singh¹,

Sehgal²,

Singh³

et al. 2017

Int. J. Curr. Res. Med. Sci

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Background: Portal hypertension is one of the complications of chronic liver disease due to cirrhosis liver. Portal vein diameter, Splenomegaly and Thrombocytopenia can be used as Non-Invasive markers for the presence of gastro-esophageal varices in cirrhotic patients. Early detection of gastro-esophageal varices can prevent the UGI variceal bleed in cirrhotic patients. Hence the correlation of portal vein diameter, splenomegaly and thrombocytopenia with Gastro-Esophageal Varices helps in early detection of gastro-esophageal varices. Method: This study was conducted on 100 patients of cirrhosis and investigations for platelet count, ultrasonography for portal vein diameter and upper GI endoscopy for esophageal varices detection were undertaken in all the patients.. Results: Our study demonstrated that thrombocytopenia, presence of portal hypertension with splenomegaly and portal vein diameter are strong predictors of developing gastro-esophageal varices in cirrhotic patients. Conclusion: in cirrhotic patients gastro-esophageal varices has direct correlation with Portal hypertension and inverse correlation with platelet count.

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“…Table 3 summarizes the findings from 3 identified peer-reviewed studies that identify risk factors for underlying esophageal varices in cirrhosis. [5][6][7] All 3 studies identify thrombocytopenia as a significant risk factor for underlying varices, with an odds ratio ranging from 1.7 to 2.8 versus patients with normal platelet counts. The presence of splenomegaly detected on physical examination has an odds ratio of 2.0, 5 and the presence of a portal vein size greater than 13 mm on ultrasonography has an odds ratio of 2.9.…”

Section: Discussionmentioning

confidence: 99%

“…Specifically, patients with either a platelet count less than 88,000/mL, a prothrombin time activity less than 70%, a portal vein diameter greater than 13 mm, or splenomegaly are considered to be at high risk for varices. [5][6][7] High-risk patients receive screening endoscopy and are placed on BB therapy if moderate or large varices are found, whereas low-risk patients are followed clinically without prophylactic therapy. High-risk patients found to have small or no varices on screening endoscopy also do not receive prophylactic therapy but subsequently undergo repeat screening endoscopy every other year.…”

Section: Decision Modelmentioning

confidence: 99%

“…The prevalence of moderate or large varices among unstratified cirrhotic patients without a history of variceal hemorrhage has been reported in several trials and ranges from 9% to 50%. [4][5][6][7]17 The mean prevalence of moderate-to-large varices in the subgroup of patients with Child's class A or B cirrhosis is 40%, [4][5][6][7]17 and we adopted this as our base case estimate. Because the precision of this estimate is unlikely to be reproduced between different populations, we varied it from 0% to 100% in our sensitivity analysis.…”

Section: Clinical Inputs and Probability Estimates Derived From Systementioning

confidence: 99%

See 1 more Smart Citation

Endoscopic screening for esophageal varices in cirrhosis: Is it ever cost effective?

Spiegel

Targownik²,

Dulai³

et al. 2003

Hepatology

142

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Current guidelines for the management of patients with compensated cirrhosis recommend universal screening endoscopy followed by prophylactic ␤-blocker therapy to prevent initial hemorrhage in those found to have esophageal varices. However, the cost-effectiveness of this recommendation has not been established. Our objective was to determine whether screening endoscopy is cost-effective compared with empiric medical management in patients with compensated cirrhosis. Decision analysis with Markov modeling was used to calculate the costeffectiveness of 6 competing strategies: (1) universal screening endoscopy (EGD) followed by ␤-blocker (BB) therapy (EGD3 BB) if varices are present, (2) EGD followed by endoscopic band ligation (EBL) (EGD3 EBL) if varices are present, (3) selective screening endoscopy (sEGD) in high risk patients followed by BB therapy if varices are present (sEGD3 BB), (4) selective screening endoscopy followed by EBL (sEGD3 EBL) if varices are present, (5) empiric ␤-blocker therapy in all patients, and (6) no prophylactic therapy ("Do Nothing"). Cost estimates were from a third-party payer perspective. The main outcome measure was the cost per initial variceal hemorrhage prevented. The "Do Nothing" strategy was the least expensive yet least effective approach. Compared with the "Do Nothing" strategy, the empiric ␤-blocker strategy cost an incremental $12,408 per additional variceal bleed prevented. Compared with the empiric ␤-blocker strategy, in turn, both the EGD3 BB and the EGD3 EBL strategies cost over $175,000 more per additional bleed prevented. The sEGD3 BB and sEGD3 EBL strategies were more expensive and less effective than the empiric ␤-blocker strategy. In conclusion, empiric ␤-blocker therapy for the primary prophylaxis of variceal hemorrhage is a cost-effective measure, as the use of screening endoscopy to guide therapy adds significant cost with only marginal increase in effectiveness. (HEPATOLOGY 2003;37:366-377.)

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Risk Factors for the Presence of Varices in Cirrhotic Patients Without a History of Variceal Hemorrhage

Abstract: Low platelet count and advanced Child-Pugh class were associated with the presence of any varices and with large varices. These factors allow identification of a subgroup of cirrhotic patients who would benefit most from referral for endoscopic screening for varices.

Cited by 157 publications

References 32 publications

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients

Correlation of portal vein diameter, splenomegaly and thrombocytopenia with gastro-espohageal varices in cirrhotic patients

Endoscopic screening for esophageal varices in cirrhosis: Is it ever cost effective?

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