Korean J Intern Med.  2019 Nov;34(6):1233-1243. 10.3904/kjim.2018.120.

Liver volume index predicts the risk of esophageal variceal hemorrhage in cirrhotic patients on propranolol prophylaxis

Affiliations
  • 1Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. kimjw@snubh.org
  • 2Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND/AIMS
Non-selective β-blockers (NSBBs) are used for primary prevention of esophageal variceal hemorrhage (VH) in patients with portal hypertension, but a significant number of patients develop VH while on NSBB therapy. In this study, we sought to determine whether liver volume can predict the risk of primary prophylaxis failure in cirrhotic patients on NSBB therapy.
METHODS
A retrospective cohort of 309 patients on prophylactic propranolol was analyzed. Liver volume was measured in portal venous phase images of multidetector computed tomography. Predictors of VH were assessed using a Cox proportional hazards model with competing-risks analysis. A nomogram was developed for estimation of the risk of primary prophylaxis failure.
RESULTS
During a median follow-up of 36 months, 37 patients on propranolol developed VH. Liver volume index, the ratio of measured-to-expected liver volume, was an independent predictor of VH (adjusted hazard ratio [HR], 2.70; 95% confidence interval [CI], 1.37 to 5.33; p = 0.004) as were the presence of large varices and the absence of ascites. A nomogram-based volume score of > 0.6 was predictive of prophylaxis failure (HR, 7.54; 95% CI, 2.88 to 19.73; p < 0.001). Time-dependent receiver operating characteristic curve analysis revealed that a nomogram-based risk score had significantly better discriminatory power than the North Italian Endoscopy Club index in predicting prophylaxis failure at 6 and 8 years.
CONCLUSIONS
Liver volume index is an independent predictor of first VH and a nomogram-based volume score stratifies the VH risk in cirrhotic patients on propranolol prophylaxis.

Keyword

Esophageal and gastric varices; Cone-beam computed tomography; Decision support techniques; Adrenergic beta-antagonists

MeSH Terms

Adrenergic beta-Antagonists
Ascites
Cohort Studies
Cone-Beam Computed Tomography
Decision Support Techniques
Endoscopy
Esophageal and Gastric Varices
Follow-Up Studies
Hemorrhage*
Humans
Hypertension, Portal
Liver*
Multidetector Computed Tomography
Nomograms
Primary Prevention
Proportional Hazards Models
Propranolol*
Retrospective Studies
ROC Curve
Varicose Veins
Adrenergic beta-Antagonists
Propranolol
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