New index to predict esophageal variceal bleeding in cirrhotic patients

被引:11
作者
Xu, Xiao-Dan [1 ]
Dai, Jian-Jun [1 ]
Qian, Jian-Qing [1 ]
Pin, Xun [1 ]
Wang, Wei-Jun [1 ]
机构
[1] Suzhou Univ, Changshu Affiliated Hosp, Dept Gastroenterol, Changshu 215500, Jiangsu, Peoples R China
关键词
Portal hypertension; Ultrasound-Doppler; Esophageal variceal bleeding; Decompensated cirrhosis; Endoscopy; LEFT GASTRIC VEIN; CHILD-PUGH SCORE; PORTAL-HYPERTENSION; LIVER-CIRRHOSIS; MELD SCORE; SURVIVAL; MODEL; HEMORRHAGE; DIAGNOSIS; DEATH;
D O I
10.3748/wjg.v20.i22.6989
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
AIM: To develop a safe, simple, noninvasive and affordable system to predict esophageal variceal bleeding (EVB) in decompensated cirrhosis patients. METHODS: Four hundred and eighty-six patients with decompensated cirrhosis (238 males and 248 females), with a mean age of 63.1 +/- 11.2 years, were admitted to Changshu Affiliated Hospital of Suzhou University between May 2008 and March 2011. Patients enrolled in this study underwent ultrasound-Doppler (US-Doppler) to assess left gastric vein (LGV) blood flow velocity (LGVV) and blood flow direction (LGVBFD), and were evaluated by the Model For End-Stage Liver Disease (MELD) scoring system. All patients received followup evaluations every three months. The resulting data were entered into a database after each time point collection. RESULTS: Four hundred and sixteen patients com-pleted follow-up evaluations for an average of 31.6 mo (range: 12 to 47 mo). Fifty-one (12.3%) patients experienced EVB. The change in the MELD score over three months (.MELD), LGVV and LGVBFD were independently associated with EVB occurrence. MELDUS- Doppler Index (MUI), a new index, was developed and calculated using the following logistic regression equation: MUI = Logit (P) = 1.667 (.MELD) + 2.096 (LGVV) -3.245 (LGVBFD) -1.697. The area under the receiver operating characteristic curve for prediction of EVB occurrence was significantly higher for the MUI [0.858 (95% CI: 0.774-0.920)] than for.MELD [0.734 (95% CI: 0.636-0.817); P < 0.05], LGVV [0.679 (95% CI: 0.578-0.769); P < 0.05] or LGVBFD [0.726 (95% CI: 0.627-0.810); P < 0.05] alone. When the MUI was set at 46, the index had high diagnostic accuracy (85.8%), with high specificity (80%) and sensitivity (87.27%). CONCLUSION: The MUI, a noninvasive and affordable index, can predict EVB occurrence in decompensated cirrhotic patients and serve as an alternative when conventional endoscopic screening is declined.
引用
收藏
页码:6989 / 6994
页数:6
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