Dr Annalisa Brigitte and colleagues from Spain developed a model based on noninvasive variables for the prediction of clinically significant portal hypertension and of esophageal varices in patients with compensated liver disease.
The team evaluated 60 patients with compensated liver cirrhosis diagnosed by histology in the training set.
|The best cutoff of the model in the training set had a sensitivity of 93%|
|The American Journal of Gastroenterology|
All patients underwent physical examination, laboratory tests, abdominal color-Doppler ultrasound, upper digestive tract endoscopy, and measurement of hepatic venous pressure gradient.
The team calculated predictive models for the presence of clinically significant portal hypertension, and of esophageal varices.
The models were validated in an independent series of 74 patients with compensated liver disease.
The researchers selected clinical and laboratory variables in the final models.
However, ultrasonography did not add statistical power for the prediction of clinically significant portal hypertension and esophageal varices.
The model for prediction of clinically significant portal hypertension included albumin, INR, and alanine aminotransferase.
The best cutoff had 93% sensitivity, and 61% specificity in the training set, and correctly classified 77% of patients in the validation set.
The team noted that spider angiomas, alanine aminotransferase, and albumin predicted esophageal varices.
The best cutoff of the model in the training set had a sensitivity of 93%, and a specificity of 37%, and correctly classified 72% of cases in the validation set.
Dr Berzigotti's team concluded, "Noninvasive prediction of esophageal varices in well-compensated cirrhotic patients is not accurate."
"However, a model obtained by combining simple laboratory variables has a high sensitivity to predict clinically significant portal hypertension in this population, and may be useful to select the subset of patients requiring screening endoscopy."
"By this method, endoscopic screening could be obviated in about 40% of patients."