Non-invasive predictors of esophageal varices with a high risk of bleeding in pediatric cirrhotic patients

• Autor(a) principal: José Ricardoborém Lopes
• Data de Publicação: 2020
• Outros Autores: Lucas Garcia de Figueiredo Colin, Alexandre Rodrigues Ferreira, Priscila Menezes Ferri Liu, Thaís Costa Nascentes Queiroz, Eleonora Druve Tavares Fagundes, Júlio Rocha Pimenta, José Andrade Franco Neto, Simone Diniz Carvalho, Maria Eduarda Marques Borges
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Institucional da UFMG
• Texto Completo: http://hdl.handle.net/1843/57191
• topic: Children; Esophageal varices; Liver cirrhosis; Crianças; Varizes Esofágicas e Gástricas; Cirrose Hepática

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.