A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease.
10.3350/cmh.2012.18.2.178
- Author:
Yang Won MIN
1
;
So Young BAE
;
Geum Youn GWAK
;
Yong Han PAIK
;
Moon Seok CHOI
;
Joon Hyoek LEE
;
Seung Woon PAIK
;
Byung Chul YOO
;
Kwang Cheol KOH
Author Information
1. Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. kckoh@skku.edu
- Publication Type:Original Article
- Keywords:
Esophageal and gastric varices;
Portal hypertensive gastropathy;
VAP score
- MeSH:
Adult;
Aged;
Chronic Disease;
Endoscopy, Gastrointestinal;
Esophageal and Gastric Varices/complications/*diagnosis;
Female;
Humans;
Hypertension, Portal/complications/*diagnosis;
Liver Diseases/complications/*diagnosis;
Male;
Middle Aged;
Platelet Count;
Predictive Value of Tests;
ROC Curve;
Retrospective Studies;
Risk Factors;
Serum Albumin/analysis;
Severity of Illness Index;
Spleen/physiology/radiography;
Tomography, X-Ray Computed
- From:Clinical and Molecular Hepatology
2012;18(2):178-184
- CountryRepublic of Korea
- Language:English
-
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)xalbumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confidence 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 cost-benefit of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.
