Predictors of esophageal varices in patients with HBV-related cirrhosis: a retrospective study
1 Department of Gastroenterology and Hepatology, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou, PR China
2 Department of General Surgery, the Second Affiliated Hospital of Wenzhou Medical College, Wenzhou, PR China
3 Department of Ultrasound, the First Affiliated Hospital of Wenzhou Medical College, Wenzhou, PR China
4 Buck Institute for Age Research, Novato, California, USA
BMC Gastroenterology 2009, 9:11 doi:10.1186/1471-230X-9-11Published: 5 February 2009
All patients with liver cirrhosis are recommended to undergo an evaluation of esophageal varices (EV) to assess their risk of bleeding. Predicting the presence of EV through non-invasive means may reduce a large number of unnecessary endoscopies. This study was designed to develop a predictive model for varices in patients with Hepatitis B virus-related cirrhosis.
The retrospective analysis was performed in 146 patients with Hepatitis B virus-related cirrhosis. The data were assessed by univariate analysis and a multivariate logistic regression analysis. In addition, the receiver operating characteristic curves were also applied to calculate and compare the accuracy of the model and other single parameters for the diagnosis of esophageal varices.
We found the prevalence of EV in patients with Hepatitis B virus-related cirrhosis to be 74.7%. In addition, platelet count, spleen width, portal vein diameter and platelet count/spleen width ratio were significantly associated with the presence of esophageal varices on univariate analysis. A multivariate analysis revealed that only the spleen width and portal vein diameter were independent risk factors. The area under the receiver operating characteristic curve of regression function (RF) model, which was composed of the spleen width and portal vein diameter, was higher than that of the platelet count. With a cut-off value of 0.3631, the RF model had an excellent sensitivity of 87.2% and an acceptable specificity of 59.5% with an overall accuracy of 80.1%.
Our data suggest that portal vein diameter and spleen width rather than platelet count may predict the presence of varices in patients with Hepatitis B virus-related cirrhosis, and that the RF model may help physicians to identify patients who would most likely benefit from screenings for EV.