Infante VM, Rosado VFC, Pérez LM, Samada SM, Hernández AM

Language: Spanish
References: 13
Page: 56-61
PDF size: 45.65 Kb.

ABSTRACT

Introduction: although endoscopy is the method of choice to identify the presence of esophageal varices in cirrhotic patients, in absence of endoscopes, it is possible to infer them by predictive factors.
Objective: to identify clinical, biochemical and ultrasonographic parameter related to the presence of esophageal varices.
Methods: an analytical and multicenter study was conducted. Inclusion and exclusion criteria were defined. Measurement were applied for clinical, haematological, and biochemical parameters, as well as for the severity of cirrhosis according to Child-Pugs. Abdominal ultrasound to measure bipolar spleen diameter and endoscopy for varices were used. Univariate and multivariate analysis were carried out.
Results: we studied 102 patients, they were mostly male (55/102, 53.9 %), this group had a mean age 55.76 ± 12.6 years. 65.7 % of cases (n = 67) had esophageal varices. Relationship was shown with the presence of ascites, varices (p = 0.002), low albumin values (p = 0.030), platelet count (p = 0.001), spleen size (p = 0.001) and the count ratio platelets/bipolar diameter spleen (p = 0.001). In multivariate analysis, only the aforementioned ratio resulted to be an independent predictive factor (OR: 0.993, 95 % CI: 0.991-0.996).
Conclusions: the significance of clinical and laboratory parameters was confirmed to predict the presence of esophageal varices, which can be used for the management of patients with cirrhosis in the absence of the possibility of endoscopy for diagnosis.

REFERENCES

1. Dib N, Konate A, Oberti F, Cales P. Non-invasive diagnosis of portal hypertension in cirrhosis. Application to the primary prevention of varices. Gastroenterol Clin Biol. 2005;29(10):975-87.

2. De Franchis R. Updating Consensus in Portal Hypertension: Report of the Baveno III Consensus Workshop on definitions, methodology and therapeutic strategies in portal hypertension. J Hepatol. 2000;33:846-52.

3. Pugh R, Murray-Lyon I, Dawson J, Pietroni M, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-9.

4. Samada M, Santos C, Hernández J, Ramos L, González L, González A, et al. Comportamiento del Child-Turcotte-Pugh y algunos indicadores nutricionales prequirúrgicos en la sobrevida de pacientes con trasplante hepático en Cuba. En: Pérez Bernal J, editor. Sevilla: Hospitales Universitarios Virgen del Rocío; 2003.

5. Samada Suárez M, Hernández Perera JC, González Rapado L, Ramos Robaina L. Aspectos específicos relacionados con el trasplante hepático en las hepatopatías por virus C. Rev Cubana Med Mil [Internet]. 2005;34(2): Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572005000200009&lng=es

6. García Ayala M, Astencio Rodríguez A, Santana Porbén S, Barreto Penié J, Martínez González C, Espinosa Borrás A. Estado nutricional de los pacientes con cirrosis hepática de causa viral. Influencia sobre la evolución natural de la enfermedad hepática y la respuesta al trasplante. Rev Nutr Clin. 2007;16(1):12-25.

7. Castellanos Fernández M, Santana Porbén S, García Jordá E, Rodríguez de Miranda A, Barreto Penié J, López Díaz Y, et al. Influencia de la desnutrición en la aparición de complicaciones y mortalidad en pacientes cirróticos. Nutrición Hospitalaria. 2008;23:68-74.

8. Samada Suárez M, Hernández Perera JC, Barroso Márquez L, Chao González L, González Hevia M, Fernández Maderos I. Identificación de factores de riesgo de presencia de várices esofágicas en pacientes con cirrosis hepática. Rev Cub Med Mil [Internet]. 2008 [citado 2011 Feb 22];37(1). Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0138-65572008000100002&lng=es

9. Testa R, Testa E, Giannini E, Borro P, Milazzo S, Isola L, et al. Noninvasive ratio indexes to evaluate fibrosis staging in chronic hepatitis C: role of platelet count/spleen diameter ratio index. J Intern Med. 2006;260(2):142-50.

10. Giannini E, Botta F, Borro P, Risso D, Romagnoli P, Fasoli A, et al. Platelet count/spleen diameter ratio: proposal and validation of a non-invasive parameter to predict the presence of oesophageal varices in patients with liver cirrhosis. Gut. 2003;52(8):1200-5.

11. Agha A, Anwar E, Bashir K, Savarino V, Giannini EG. External validation of the platelet count/spleen diameter ratio for the diagnosis of esophageal varices in hepatitis C virus-related cirrhosis. Dig Dis Sci. 2009;54(3):654-60.

12. Alempijevic T, Krstic M, Jesic R, Jovanovic I, Sokic Milutinovic A, Kovacevic N, et al. Biochemical markers for non-invasive assessment of disease stage in patients with primary biliary cirrhosis. World J Gastroenterol. 2009;15(5):591-4.

13. Plestina S, Pulanic R, Kralik M, Samarzija M. Color Doppler ultrasonography is reliable in assessing the risk of esophageal variceal bleeding in patients with liver cirrhosis. Wien Klin Wochenschr. 2005;117(19-20):711-7.