Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension
Non-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertension without cirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low likelihood of high risk varices (HRV)...
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| Format: | Article |
| Language: | English |
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Wiley
2019-01-01
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| Series: | Canadian Journal of Gastroenterology and Hepatology |
| Online Access: | http://dx.doi.org/10.1155/2019/1808797 |
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| author | Morven E. Cunningham Gilda Parastandeh-Chehr Orlando Cerocchi David K. Wong Keyur Patel |
| author_facet | Morven E. Cunningham Gilda Parastandeh-Chehr Orlando Cerocchi David K. Wong Keyur Patel |
| author_sort | Morven E. Cunningham |
| collection | DOAJ |
| description | Non-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertension without cirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low likelihood of high risk varices (HRV) in patients with a liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 109/L. In NCPH, LSM is often higher than healthy controls but lower than matched cirrhotic patients. The aim of this study was to assess whether LSM or other noninvasive assessments of portal hypertension could predict HRV in NCPH patients. Methods. Records of patients with NCPH seen at a single centre between 2007 and 2018 were reviewed retrospectively. Primary outcome measure was presence or absence of HRV at gastroscopy within 12 months of clinical assessment. Association of LSM or other clinical features of portal hypertension (spleen size, platelet count, platelet count/spleen length ratio (PSL), LSM-spleen length/platelet count ratio score (LSP)) with HRV and ability of these variables to predict HRV was analysed. Results. Of 44 patients with NCPH who met inclusion criteria, 34% (15/44) had HRV. In a multivariate model, spleen size and PSL correlated with HRV but platelet count, LSM, and LSP did not (spleen size: β = 0.35, p = 0.02; OR 1.42, 95% CI 1.06-1.92; PSL: β = -1.47, p = 0.02; OR 0.23, 95% CI 0.07-0.80). There was no significant difference between spleen size and PSL in predicting HRV (AUROC 0.81 (95% CI 0.66 – 0.91) versus 0.71 (95% CI 0.54 – 0.84), respectively, p = 0.400). Spleen size >17.2cm had sensitivity 78.6% and specificity 64.3% for prediction of HRV. Conclusions. In NCPH patients, spleen size may predict risk of HRV at gastroscopy within 12 months. LSM and platelet count are not useful to assess risk of HRV in NCPH. |
| format | Article |
| id | doaj-art-06fb65539a9a44fcb2de452133b214bf |
| institution | Kabale University |
| issn | 2291-2789 2291-2797 |
| language | English |
| publishDate | 2019-01-01 |
| publisher | Wiley |
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| series | Canadian Journal of Gastroenterology and Hepatology |
| spelling | doaj-art-06fb65539a9a44fcb2de452133b214bf2025-02-03T01:26:00ZengWileyCanadian Journal of Gastroenterology and Hepatology2291-27892291-27972019-01-01201910.1155/2019/18087971808797Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal HypertensionMorven E. Cunningham0Gilda Parastandeh-Chehr1Orlando Cerocchi2David K. Wong3Keyur Patel4Toronto Centre for Liver Disease, University Hospital Network, Toronto M5G 2C4, CanadaToronto Centre for Liver Disease, University Hospital Network, Toronto M5G 2C4, CanadaToronto Centre for Liver Disease, University Hospital Network, Toronto M5G 2C4, CanadaToronto Centre for Liver Disease, University Hospital Network, Toronto M5G 2C4, CanadaToronto Centre for Liver Disease, University Hospital Network, Toronto M5G 2C4, CanadaNon-cirrhotic portal hypertension (NCPH) comprises a heterogeneous group of liver disorders causing portal hypertension without cirrhosis and carries a high risk of variceal bleeding. Recent guidelines, based largely on patients with viral cirrhosis, suggest low likelihood of high risk varices (HRV) in patients with a liver stiffness measurement (LSM) <20 kPa and platelet count >150 × 109/L. In NCPH, LSM is often higher than healthy controls but lower than matched cirrhotic patients. The aim of this study was to assess whether LSM or other noninvasive assessments of portal hypertension could predict HRV in NCPH patients. Methods. Records of patients with NCPH seen at a single centre between 2007 and 2018 were reviewed retrospectively. Primary outcome measure was presence or absence of HRV at gastroscopy within 12 months of clinical assessment. Association of LSM or other clinical features of portal hypertension (spleen size, platelet count, platelet count/spleen length ratio (PSL), LSM-spleen length/platelet count ratio score (LSP)) with HRV and ability of these variables to predict HRV was analysed. Results. Of 44 patients with NCPH who met inclusion criteria, 34% (15/44) had HRV. In a multivariate model, spleen size and PSL correlated with HRV but platelet count, LSM, and LSP did not (spleen size: β = 0.35, p = 0.02; OR 1.42, 95% CI 1.06-1.92; PSL: β = -1.47, p = 0.02; OR 0.23, 95% CI 0.07-0.80). There was no significant difference between spleen size and PSL in predicting HRV (AUROC 0.81 (95% CI 0.66 – 0.91) versus 0.71 (95% CI 0.54 – 0.84), respectively, p = 0.400). Spleen size >17.2cm had sensitivity 78.6% and specificity 64.3% for prediction of HRV. Conclusions. In NCPH patients, spleen size may predict risk of HRV at gastroscopy within 12 months. LSM and platelet count are not useful to assess risk of HRV in NCPH.http://dx.doi.org/10.1155/2019/1808797 |
| spellingShingle | Morven E. Cunningham Gilda Parastandeh-Chehr Orlando Cerocchi David K. Wong Keyur Patel Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension Canadian Journal of Gastroenterology and Hepatology |
| title | Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension |
| title_full | Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension |
| title_fullStr | Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension |
| title_full_unstemmed | Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension |
| title_short | Noninvasive Predictors of High-Risk Varices in Patients with Non-Cirrhotic Portal Hypertension |
| title_sort | noninvasive predictors of high risk varices in patients with non cirrhotic portal hypertension |
| url | http://dx.doi.org/10.1155/2019/1808797 |
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