A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease

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 (/mm(3))×albumin (g/dL)]/[M-Index (cm(3))]). 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.

Keywords: Esophageal and gastric varices; Portal hypertensive gastropathy; VAP score.

Figure 1

Comparison of receiver operating characteristic curves between the varices and portal hypertensive gastropathy score and the platelet count/spleen diameter ratio for predicting of esophageal varices, gastric varices, and portal hypertensive gastropathy. VAP, varices and portal hypertensive gastropathy; Plt/S-D ratio, platelet count/spleen diameter ratio.