The factors predictive of the presence or the absence of esophageal varices in Hepatitis C virus and advanced fibrosis have not been defined.
Dr Arun Sanya and colleagues from Virginia defined the prevalence of esophageal varices in Hepatitis C and advanced fibrosis.
The team of investigators also evaluated the factors that are positively and negatively correlated with such varices.
The investigators accessed prerandomized data from the HALT-C (Hepatitis C long-term antiviral treatment against cirrhosis) clinical trial.
Subjects with bridging fibrosis or cirrhosis, who were virologic nonresponders to treatment with pegylated interferon alpha 2a and ribavirin, underwent endoscopy.
The team found that 16% of subjects with bridging fibrosis, and 39% of subjects with cirrhosis had varices.
|The risk of varices increased at platelet counts more than 150,000/mm3|
The investigators noted that 2% of subjects with bridging fibrosis, and 11% of those with cirrhosis had medium or large varices.
Subjects with bridging fibrosis and varices had a significantly lower platelet count.
The team observed that those with bridging fibrosis also had higher bilirubin and international normalized ratio compared with those without varices.
The investigators suggested that the biopsy may have underestimated the severity of fibrosis.
A platelet count of more than 150,000/mm3 was associated with a negative predictive value of 99% for esophageal varices.
By logistic regression modeling, the team observed that African American race and female sex were protective.
In addition, the researchers found that a lower platelet count and higher bilirubin and international normalized ratio predicted varices.
Dr Sanya's team concludes, “The risk of having varices increases with decreasing platelet counts, increasing bilirubin, and international normalized ratio.”
“The probability of having medium or large varices at platelet counts more than 150,000/mm3 is negligible in this population.”