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KMID : 1103920120180020178
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Korean Journal of Hepatology
2012 Volume.18 No. 2 p.178 ~ p.184
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A clinical predictor of varices and portal hypertensive gastropathy in patients with chronic liver disease
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Min Yang-Won
Bae So-Young
Gwak Geum-Youn
Paik Yong-Han
Choi Moon-Seok
Lee Joon-Hyoek
Paik Seung-Woon
Yoo Byung-Chul
Koh Kwang-Cheol
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Abstract
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Background/Aims: The aim of this study was to identify the parameters that could noninvasively predict the presence of esophageal/gastric varices and portal hypertensive gastropathy (PHG) in patients with chronic liver disease (CLD), and to determine the accuracy of those parameters.
Methods: We retrospectively analyzed 232 patients with CLD who underwent both upper endoscopy and liver CT within an interval of 3 months. The multidimensional index (M-Index) for spleen volume was obtained from the multiplication of splenic length, width, and thickness, as measured by computer tomography.
Results: The multivariate analysis revealed that platelet, albumin, and M-Index were independently associated with the presence of varices and PHG. We combined three independent parameters, and developed a varices and portal hypertensive gastropathy (VAP) scoring system (=[platelet count (/mm3)×albumin (g/dL)]/[M-Index (cm3)]). The area under the receiver operating characteristic curve of the VAP score was 0.850 (95% confi dence interval, 0.801-0.899). The VAP cut-off value of 861 had a sensitivity of 85.3%, a positive likelihood ratio of 3.17, and a negative predictive value of 86.4%. For predicting high-risk lesions for bleeding, with a cut-off value of 861 the sensitivity was 92.0%, the positive likelihood ratio was 2.20, and the negative predictive value was 96.4%.
Conclusions: The VAP score can predict the presence of varices and PHG in patients with CLD and may increase the costbenefi t of screening endoscopy in the clinical practice setting. A prospective validation study is necessary in the future.
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KEYWORD
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Esophageal and gastric varices, Portal hypertensive gastropathy, VAP score
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