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. 2012 Jun;18(2):178-84.
doi: 10.3350/cmh.2012.18.2.178. Epub 2012 Jun 26.

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

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
Affiliations

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

Yang Won Min et al. Clin Mol Hepatol. 2012 Jun.

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.

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Conflict of interest statement

The authors have no conflicts to disclose.

Figures

Figure 1
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.
See this image and copyright information in PMC

References

    1. de Franchis R. Evolving consensus in portal hypertension. Report of the Baveno IV consensus workshop on methodology of diagnosis and therapy in portal hypertension. J Hepatol. 2005;43:167–176. - PubMed
    1. North Italian Endoscopic Club for the Study and Treatment of Esophageal Varices. Prediction of the first variceal hemorrhage in patients with cirrhosis of the liver and esophageal varices. A prospective multicenter study. N Engl J Med. 1988;319:983–989. - PubMed
    1. Smith JL, Graham DY. Variceal hemorrhage: a critical evaluation of survival analysis. Gastroenterology. 1982;82:968–973. - PubMed
    1. Merli M, Nicolini G, Angeloni S, Gentili F, Attili AF, Riggio O. The natural history of portal hypertensive gastropathy in patients with liver cirrhosis and mild portal hypertension. Am J Gastroenterol. 2004;99:1959–1965. - PubMed
    1. Thuluvath PJ, Yoo HY. Portal Hypertensive gastropathy. Am J Gastroenterol. 2002;97:2973–2978. - PubMed

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