Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients.
Portal hemodynamics as predictors of high risk esophageal varices in cirrhotic patients.
AIM: To evaluate portal hypertension parameters in liver cirrhosis patients with and without esophageal varices (EV). METHODS: A cohort of patients with biopsy confirmed liver cirrhosis was investigated endoscopically and with color Doppler ultrasonography as a possible non-invasive predictive tool. The relationship between portal hemodynamics and the presence and size of EV was evaluated using uni- and multivariate approaches. RESULTS: Eighty five consecutive cirrhotic patients (43 men and 42 women) were enrolled. Mean age (+/- SD) was 47.5 (+/- 15.9). Portal vein diameter (13.88 +/- 2.42 vs 12.00 +/- 1.69, P < 0.0005) and liver vascular index (8.31 +/- 2.72 vs 17.8 +/- 6.28, P < 0.0005) were found to be significantly higher in patients with EV irrespective of size and in patients with large varices (14.54 +/- 1.48 vs 13.24 +/- 2.55, P < 0.05 and 6.45 +/- 2.78 vs 10.96 +/- 5.05, P < 0.0005, respectively), while portal vein flow velocity (13.25 +/- 3.66 vs 20.25 +/- 5.05, P < 0.0005), congestion index (CI) (0.11 +/- 0.03 vs 0.06 +/- 0.03, P < 0.0005), portal hypertensive index (2.62 +/- 0.79 vs 1.33 +/- 0.53, P < 0.0005), and hepatic (0.73 +/- 0.07 vs 0.66 +/- 0.07, P < 0.001) and splenic artery resistance index (RI) (0.73 +/- 0.06 vs 0.62 +/- 0.08, P < 0.0005) were significantly lower. A logistic regression model confirmed spleen size (P = 0.002, AUC 0.72) and portal hypertensive index (P = 0.040, AUC 0.79) as independent predictors for the occurrence of large esophageal varices (LEV). CONCLUSION: Our data suggest two independent situations for beginning endoscopic evaluation of compensated cirrhotic patients: Portal hypertensive index > 2.08 and spleen size > 15.05 cm. These factors may help identifying patients with a low probability of LEV who may not need upper gastrointestinal endoscopy.
Tarzamni MK, Somi MH, Farhang S, Jalilvand M.
Liver and Gastrointestinal Diseases Research Center, Imam Hospital, University Ave, Tabriz, East Azerbaijan, Iran. sfarhang@yahoo.com.