2 351

Cited 116 times in

A liver stiffness measurement-based, noninvasive prediction model for high-risk esophageal varices in B-viral liver cirrhosis

Authors
 Beom Kyung Kim  ;  Kwang-Hyub Han  ;  Jun Yong Park  ;  Sang Hoon Ahn  ;  Ja Kyung Kim  ;  Yong Han Paik  ;  Kwan Sik Lee  ;  Chae Yoon Chon  ;  Do Young Kim 
Citation
 AMERICAN JOURNAL OF GASTROENTEROLOGY, Vol.105(6) : 1382-1390, 2010 
Journal Title
 AMERICAN JOURNAL OF GASTROENTEROLOGY 
ISSN
 0002-9270 
Issue Date
2010
MeSH
Adult ; Esophageal and Gastric Varices/diagnosis* ; Esophageal and Gastric Varices/diagnostic imaging ; Esophagoscopy ; Female ; Hepatitis B/complications* ; Humans ; Liver Cirrhosis/diagnosis* ; Liver Cirrhosis/diagnostic imaging ; Liver Cirrhosis/virology ; Male ; Middle Aged ; Predictive Value of Tests ; Reproducibility of Results ; Ultrasonography
Abstract
OBJECTIVES: Periodic endoscopic screening for esophageal varices (EVs) and prophylactic treatment for high-risk EVs ((HEVs); (1) medium/large EVs and (2) small EVs with red sign or decompensated cirrhosis) are currently recommended for all cirrhotic patients. However, if a simple, noninvasive test is available, many low-risk patients may safely avoid endoscopy. We developed and validated a new liver stiffness measurement (LSM)-based prediction model for HEVs. METHODS: We prospectively enrolled 280 consecutive B-viral cirrhosis patients from 2005 to 2007 (training set) and 121 from 2007 to 2008 (validation set). All underwent laboratory workups, endoscopy, LSM, and ultrasonography. For detection of HEVs, univariate and multivariate analysis were performed, using chi2-test/t-test and logistic regression, respectively. A prediction model was derived from multivariate predictors. RESULTS: In the training set, 90 had HEVs, and multivariate analysis showed significant differences in LSM, spleen diameter, and platelet count between patients with and without HEVs. We developed LSM-spleen diameter to platelet ratio score (LSPS): LSM x spleen diameter/platelet count. The area under the receiver-operating characteristic curve (AUROC) in the training set was 0.954. At LSPS<3.5, 94.0% negative predictive value (NPV) was provided (184 patients), whereas 94.2% positive predictive value (PPV) was achieved (69 patients) at LSPS>5.5. Overall, the likelihood of HEVs was correctly diagnosed in 253 patients (90.3%). Its predictive values were maintained at similar accuracy in subsequent validation set (AUROC=0.953; 94.7% NPV/93.3% PPV at cutoff 3.5/5.5, respectively). CONCLUSIONS: LSPS is a reliable, noninvasive method for detection of HEVs. Patients with LSPS<3.5 may avoid endoscopy safely, whereas those with LSPS>5.5 should be considered for appropriate prophylactic treatments
Full Text
http://www.nature.com/ajg/journal/v105/n6/full/ajg2009750a.html
DOI
10.1038/ajg.2009.750
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Do Young(김도영)
Kim, Beom Kyung(김범경) ORCID logo https://orcid.org/0000-0002-5363-2496
Kim, Ja Kyung(김자경) ORCID logo https://orcid.org/0000-0001-5025-6846
Park, Jun Yong(박준용) ORCID logo https://orcid.org/0000-0001-6324-2224
Paik, Yong Han(백용한)
Ahn, Sang Hoon(안상훈) ORCID logo https://orcid.org/0000-0002-3629-4624
Lee, Kwan Sik(이관식) ORCID logo https://orcid.org/0000-0002-3672-1198
Chon, Chae Yoon(전재윤)
Han, Kwang-Hyub(한광협) ORCID logo https://orcid.org/0000-0003-3960-6539
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/101229
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse