Predictors of large esophageal varices in patients with cirrhosis

Naga Chalasani, Thomas F. Imperiale, Ayaaz Ismail, Gagan Sood, Mark Carey, C. Mel Wilcox, Hari Madichetty, Paul Y. Kwo, Thomas D Boyer

Research output: Contribution to journalArticle

168 Citations (Scopus)

Abstract

OBJECTIVE: Recent guidelines recommend that all cirrhotics undergo screening upper endoscopy to identify those patients at risk for bleeding from varices. However, this practice may not be cost effective as large esophageal varices are seen only in 9-36% of these patients. The aim of this study was to determine whether clinical variables were predictive of the presence of large esophageal varices. METHODS: This is a retrospective analysis of cirrhotics who had a screening upper endoscopy during an evaluation for liver transplantation at three different centers and who had not previously bled from varices. A multivariate model was derived on the combined cohort using logistic regression. Three hundred forty-six patients were eligible for the study. RESULTS: The prevalence of large esophageal varices was 20%. On multivariate analysis, splenomegaly detected by computed tomographic scan (odds ratio: 4.3; 95% confidence interval: 1.6-11.5) or by physical examination (odds ratio: 2.0; 95% confidence interval: 1.1-3.8), and low plate- let count were independent predictors of large esophageal varices. On the basis of these variables, cirrhotics were stratified into high- and low-risk groups for the presence of large esophageal varices. Patients with a platelet count of ≥88,000/mm3 (median value) and no splenomegaly by physical examination had a risk of large esophageal varices of 7.2%. Those with splenomegaly or platelet count < 88,000/mm3 had a risk of large esophageal varices of 28% (p < 0.0001). CONCLUSIONS: Our data show that clinical predictors could be used to stratify cirrhotic patients for the risk of large esophageal varices and such stratification could be used to improve the cost effectiveness of screening endoscopy.

Original languageEnglish (US)
Pages (from-to)3285-3291
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume94
Issue number11
DOIs
StatePublished - Nov 1999
Externally publishedYes

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Esophageal and Gastric Varices
Fibrosis
Splenomegaly
Endoscopy
Varicose Veins
Platelet Count
Physical Examination
Odds Ratio
Confidence Intervals
Liver Transplantation
Cost-Benefit Analysis
Multivariate Analysis
Logistic Models
Guidelines
Hemorrhage
Costs and Cost Analysis

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Chalasani, N., Imperiale, T. F., Ismail, A., Sood, G., Carey, M., Wilcox, C. M., ... Boyer, T. D. (1999). Predictors of large esophageal varices in patients with cirrhosis. American Journal of Gastroenterology, 94(11), 3285-3291. https://doi.org/10.1016/S0002-9270(99)00598-5

Predictors of large esophageal varices in patients with cirrhosis. / Chalasani, Naga; Imperiale, Thomas F.; Ismail, Ayaaz; Sood, Gagan; Carey, Mark; Wilcox, C. Mel; Madichetty, Hari; Kwo, Paul Y.; Boyer, Thomas D.

In: American Journal of Gastroenterology, Vol. 94, No. 11, 11.1999, p. 3285-3291.

Research output: Contribution to journalArticle

Chalasani, N, Imperiale, TF, Ismail, A, Sood, G, Carey, M, Wilcox, CM, Madichetty, H, Kwo, PY & Boyer, TD 1999, 'Predictors of large esophageal varices in patients with cirrhosis', American Journal of Gastroenterology, vol. 94, no. 11, pp. 3285-3291. https://doi.org/10.1016/S0002-9270(99)00598-5
Chalasani N, Imperiale TF, Ismail A, Sood G, Carey M, Wilcox CM et al. Predictors of large esophageal varices in patients with cirrhosis. American Journal of Gastroenterology. 1999 Nov;94(11):3285-3291. https://doi.org/10.1016/S0002-9270(99)00598-5
Chalasani, Naga ; Imperiale, Thomas F. ; Ismail, Ayaaz ; Sood, Gagan ; Carey, Mark ; Wilcox, C. Mel ; Madichetty, Hari ; Kwo, Paul Y. ; Boyer, Thomas D. / Predictors of large esophageal varices in patients with cirrhosis. In: American Journal of Gastroenterology. 1999 ; Vol. 94, No. 11. pp. 3285-3291.
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abstract = "OBJECTIVE: Recent guidelines recommend that all cirrhotics undergo screening upper endoscopy to identify those patients at risk for bleeding from varices. However, this practice may not be cost effective as large esophageal varices are seen only in 9-36{\%} of these patients. The aim of this study was to determine whether clinical variables were predictive of the presence of large esophageal varices. METHODS: This is a retrospective analysis of cirrhotics who had a screening upper endoscopy during an evaluation for liver transplantation at three different centers and who had not previously bled from varices. A multivariate model was derived on the combined cohort using logistic regression. Three hundred forty-six patients were eligible for the study. RESULTS: The prevalence of large esophageal varices was 20{\%}. On multivariate analysis, splenomegaly detected by computed tomographic scan (odds ratio: 4.3; 95{\%} confidence interval: 1.6-11.5) or by physical examination (odds ratio: 2.0; 95{\%} confidence interval: 1.1-3.8), and low plate- let count were independent predictors of large esophageal varices. On the basis of these variables, cirrhotics were stratified into high- and low-risk groups for the presence of large esophageal varices. Patients with a platelet count of ≥88,000/mm3 (median value) and no splenomegaly by physical examination had a risk of large esophageal varices of 7.2{\%}. Those with splenomegaly or platelet count < 88,000/mm3 had a risk of large esophageal varices of 28{\%} (p < 0.0001). CONCLUSIONS: Our data show that clinical predictors could be used to stratify cirrhotic patients for the risk of large esophageal varices and such stratification could be used to improve the cost effectiveness of screening endoscopy.",
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AU - Ismail, Ayaaz

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AU - Carey, Mark

AU - Wilcox, C. Mel

AU - Madichetty, Hari

AU - Kwo, Paul Y.

AU - Boyer, Thomas D

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N2 - OBJECTIVE: Recent guidelines recommend that all cirrhotics undergo screening upper endoscopy to identify those patients at risk for bleeding from varices. However, this practice may not be cost effective as large esophageal varices are seen only in 9-36% of these patients. The aim of this study was to determine whether clinical variables were predictive of the presence of large esophageal varices. METHODS: This is a retrospective analysis of cirrhotics who had a screening upper endoscopy during an evaluation for liver transplantation at three different centers and who had not previously bled from varices. A multivariate model was derived on the combined cohort using logistic regression. Three hundred forty-six patients were eligible for the study. RESULTS: The prevalence of large esophageal varices was 20%. On multivariate analysis, splenomegaly detected by computed tomographic scan (odds ratio: 4.3; 95% confidence interval: 1.6-11.5) or by physical examination (odds ratio: 2.0; 95% confidence interval: 1.1-3.8), and low plate- let count were independent predictors of large esophageal varices. On the basis of these variables, cirrhotics were stratified into high- and low-risk groups for the presence of large esophageal varices. Patients with a platelet count of ≥88,000/mm3 (median value) and no splenomegaly by physical examination had a risk of large esophageal varices of 7.2%. Those with splenomegaly or platelet count < 88,000/mm3 had a risk of large esophageal varices of 28% (p < 0.0001). CONCLUSIONS: Our data show that clinical predictors could be used to stratify cirrhotic patients for the risk of large esophageal varices and such stratification could be used to improve the cost effectiveness of screening endoscopy.

AB - OBJECTIVE: Recent guidelines recommend that all cirrhotics undergo screening upper endoscopy to identify those patients at risk for bleeding from varices. However, this practice may not be cost effective as large esophageal varices are seen only in 9-36% of these patients. The aim of this study was to determine whether clinical variables were predictive of the presence of large esophageal varices. METHODS: This is a retrospective analysis of cirrhotics who had a screening upper endoscopy during an evaluation for liver transplantation at three different centers and who had not previously bled from varices. A multivariate model was derived on the combined cohort using logistic regression. Three hundred forty-six patients were eligible for the study. RESULTS: The prevalence of large esophageal varices was 20%. On multivariate analysis, splenomegaly detected by computed tomographic scan (odds ratio: 4.3; 95% confidence interval: 1.6-11.5) or by physical examination (odds ratio: 2.0; 95% confidence interval: 1.1-3.8), and low plate- let count were independent predictors of large esophageal varices. On the basis of these variables, cirrhotics were stratified into high- and low-risk groups for the presence of large esophageal varices. Patients with a platelet count of ≥88,000/mm3 (median value) and no splenomegaly by physical examination had a risk of large esophageal varices of 7.2%. Those with splenomegaly or platelet count < 88,000/mm3 had a risk of large esophageal varices of 28% (p < 0.0001). CONCLUSIONS: Our data show that clinical predictors could be used to stratify cirrhotic patients for the risk of large esophageal varices and such stratification could be used to improve the cost effectiveness of screening endoscopy.

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