Non-invasive predictors of esophageal varices with a high risk of bleeding in pediatric cirrhotic patients
Objectives: To evaluate non-invasive predictive factors of varices with a high risk of bleeding in pediatric cirrhotic patients.Methods: This retrospective, cross-sectional study included data from 158 children with cirrhosis, median age of 5.38 years (interquartile [IQ]2.0811.52 years), and no hist...
| Autores: | , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2020 |
| País: | Brasil |
| Institución: | Universidade Federal de Minas Gerais (UFMG) |
| Repositorio: | Repositório Institucional da UFMG |
| Idioma: | inglés |
| OAI Identifier: | oai:repositorio.ufmg.br:1843/57191 |
| Acceso en línea: | http://hdl.handle.net/1843/57191 |
| Access Level: | acceso abierto |
| Palabra clave: | Children Esophageal varices Liver cirrhosis Crianças Varizes Esofágicas e Gástricas Cirrose Hepática |
| Sumario: | Objectives: To evaluate non-invasive predictive factors of varices with a high risk of bleeding in pediatric cirrhotic patients.Methods: This retrospective, cross-sectional study included data from 158 children with cirrhosis, median age of 5.38 years (interquartile [IQ]2.0811.52 years), and no history of upper gastrointestinal bleeding.Patients underwent an endoscopy to screen for esophageal varices. Varices with a high risk of bleeding were defined as those with a medium to large caliber, presence of red spots, or the presence of gastric varices and identified as high-risk varices (HRV). Laboratory and clinical factors were evaluated as possible predictors of HRV. Results: HRV were detected in 30 children (19%) after the first endoscopy. In the multivariate analysis, only the risk score (RS), as described by Park et al, and the aspartate aminotransferase-to-platelet ratio index (APRi) were predictive of HRV. The best non-invasive predictor of HRV was the RS with an area under the receiver operating characteristic curve of 0.764. When used a cut-off point of 1.2, the sensitivity of the RS was 90% and specificity was 53%. The use of RS or APRi correctly identified 96% of children with HRV. Conclusions: The described predictors allow the correct identification of patients with HRV. The association of RS >1.2 or APRi >1.4 has a good sensitivity to identify HRV and to prevent unnecessary endoscopy in about one-third of children with no HRV. |
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