BACKGROUND: A model developed by our group identified low platelets and advanced Child-Pugh class (CPC) as being associated with large varices. GOALS: To validate a defined cut-off of platelets < or =80,000/microL in CPC-A for large varices and platelets < or =90,000/microL in CPC-B/C for any varices. STUDY: Validation cohorts consisted of patients with cirrhosis undergoing screening for varices from Oregon Health and Science University (n=152), Indiana University (n=252), and Genoa, Italy (n=101). Similar clinical and laboratory data were collected as for the original cohort. To assess the ability of these cut-offs to predict presence of large and any varices, sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the c-statistic were measured. RESULTS: The validation cohorts were statistically different from the original cohort with regards to CPC and prevalence of large varices. Combining the original (n=301) and validation cohorts resulted in a negative predictive value of 92.1% for platelets < or =80,000/microL in CPC-A for large varices and positive predictive value of 80.1% for platelets < or =90,000/microL in CPC-B/C for any varices. Combining the 4 cohorts yielded a c-statistic of 0.67 (95% confidence interval: 063-0.72). No other factors such as splenomegaly and Model for End-Stage Liver Disease score were identified as significant. CONCLUSIONS: This study confirms the validity of a previous model identifying low platelets and advanced CPC class as predictors of large varices. Despite combining the cohorts, no other risk factors were identified.
BACKGROUND: A model developed by our group identified low platelets and advanced Child-Pugh class (CPC) as being associated with large varices. GOALS: To validate a defined cut-off of platelets < or =80,000/microL in CPC-A for large varices and platelets < or =90,000/microL in CPC-B/C for any varices. STUDY: Validation cohorts consisted of patients with cirrhosis undergoing screening for varices from Oregon Health and Science University (n=152), Indiana University (n=252), and Genoa, Italy (n=101). Similar clinical and laboratory data were collected as for the original cohort. To assess the ability of these cut-offs to predict presence of large and any varices, sensitivity, specificity, positive and negative predictive values, likelihood ratios, and the c-statistic were measured. RESULTS: The validation cohorts were statistically different from the original cohort with regards to CPC and prevalence of large varices. Combining the original (n=301) and validation cohorts resulted in a negative predictive value of 92.1% for platelets < or =80,000/microL in CPC-A for large varices and positive predictive value of 80.1% for platelets < or =90,000/microL in CPC-B/C for any varices. Combining the 4 cohorts yielded a c-statistic of 0.67 (95% confidence interval: 063-0.72). No other factors such as splenomegaly and Model for End-Stage Liver Disease score were identified as significant. CONCLUSIONS: This study confirms the validity of a previous model identifying low platelets and advanced CPC class as predictors of large varices. Despite combining the cohorts, no other risk factors were identified.
Authors: Agostino Colli; Juan Cristóbal Gana; Jason Yap; Thomasin Adams-Webber; Natalie Rashkovan; Simon C Ling; Giovanni Casazza Journal: Cochrane Database Syst Rev Date: 2017-04-26
Authors: Robert J Fontana; Arun J Sanyal; Marc G Ghany; William M Lee; Andrea E Reid; Deepa Naishadham; Gregory T Everson; Jeffrey A Kahn; Adrian M Di Bisceglie; Gyongyi Szabo; Timothy R Morgan; James E Everhart Journal: Gastroenterology Date: 2010-03-06 Impact factor: 22.682
Authors: Sarmed S Sami; David Harman; Krish Ragunath; Dankmar Böhning; Julie Parkes; Indra Neil Guha Journal: United European Gastroenterol J Date: 2018-03-22 Impact factor: 4.623