The predictive value of serum laminin for the risk of variceal bleeding related to portal pressure levels.
OBJECTIVE
This paper presents the results of the radioimmunologic determination of laminin in serum of patients with alcoholic liver cirrhosis with a preserved hepatic function, trying to evaluate its predictive value for the risk of variceal bleeding, assessed by a portal pressure level equal to or higher than 12 mmHg.


METHODS
Twenty alcoholic cirrhotic patients with a preserved hepatic function as assessed by the Child-Pugh classification, had their peripheral blood taken for radioimmunological determination of serum laminin and were submitted to hepatic vein catheterization for portal pressure measurement.


RESULTS
A positive and significant correlation (r = 0.70, p < 0.001) was found between serum laminin levels (mean value + SD = 2.70 + 1.13 U/ml) and hepatic vein pressure gradient (mean HVPG + SD = 16.30 + 6.06 mmHg). Such correlation prompted us to find a value for the level of laminin that more closely represented a HVPG of 12 mmHg, a well known threshold pressure for esophageal varices bleeding. At a cut-off concentration for laminin of 2.19 U/ml, sensitivity was 73%, specificity 60%, the positive predictive value was 85% and the negative predictive value 43%. In this study population, with a prevalence of 75% of a HVPG > or = 12 mmHg, the diagnostic accuracy for such levels of serum laminin was 70%.


CONCLUSIONS
Although a valid attempt in having a non invasive parameter for the investigation of portal hypertension, peripheral serum laminin alone doesn't seem to be a reliable marker for predicting portal hypertension and to assess the risk of variceal bleeding in patients with alcoholic cirrhosis.
Kondo
M
M
Gastroenterology Section, Escola Paulista De Medicina, Sao Paulo, Brazil.
Miszputen
S J
SJ
Leite-mor
M M
MM
Parise
E R
ER
D000328:Adult; D000368:Aged; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000150:complications*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000097:blood / Q000150:complications / Q000503:physiopathology*; D007797:Laminin / Q000097:blood*; D008104:Liver Cirrhosis, Alcoholic / Q000097:blood* / Q000150:complications / Q000503:physiopathology; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D017082:Portal Pressure / Q000502:physiology*; D011379:Prognosis; D012307:Risk Factors; D012680:Sensitivity and Specificity
D007797:Laminin