Clin Mol Hepatol.  2012 Jun;18(2):178-184. 10.3350/cmh.2012.18.2.178.

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

• Min YW
• Bae SY
• Gwak GY
• Paik YH
• Choi MS
• Lee JH
• Paik SW
• Yoo BC
• Koh KC

• KMID: 1743725
• DOI: http://doi.org/10.3350/cmh.2012.18.2.178

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.

Keyword

Esophageal and gastric varices; Portal hypertensive gastropathy; VAP score

MeSH Terms

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