Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome.
OBJECTIVE
To determine the clinical and laboratory parameters that may predict the presence of esophageal varices in children and adolescents with portal hypertension.


METHODS
Overall, 111 patients with portal hypertension and no previous history of digestive bleeding underwent esophagogastroduodenoscopy for detection of esophageal varices. A univariate analysis initially was carried out, followed by a logistic regression analysis to identify the independent variables associated with the presence of esophageal varices. Sensitivity and specificity rates, positive predictive value, negative predictive value, and the accuracy of the predictive variables identified among cirrhotic patients were calculated with the esophagogastroduodenoscopy as the reference test.


RESULTS
Sixty percent of patients had esophageal varices on the first esophagogastroduodenoscopy. Patients with portal vein thrombosis and congenital hepatic fibrosis were 6.15-fold more likely to have esophageal varices than cirrhotic patients. When we analyzed 85 cirrhotic patients alone, splenomegaly and hypoalbuminemia remained significant indicators of esophageal varices. Only spleen enlargement showed appropriate sensitivity and negative predictive value (97.7% and 91.7%, respectively) to be used as a screening test for esophageal varices among cirrhotic patients.


CONCLUSIONS
In reference services and research protocols, endoscopic screening should be performed in all patients with portal vein thrombosis and congenital hepatic fibrosis. Among cirrhotic patients, the indication should be conditioned to clinical evidence of splenomegaly or hypoalbuminemia. For clinicians, the recommendation is to emphasize the orientations given to guardians of patients with portal vein thrombosis and congenital hepatic fibrosis as to the risk of digestive bleeding. Cirrhotic patients with hypoalbuminemia and splenomegaly should receive the same orientations.
Fagundes
Eleonora Druve Tavares
ED
Department of Pediatrics, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Ferreira
Alexandre Rodrigues
AR
Roquete
Mariza Leitão Valadares
ML
Penna
Francisco José
FJ
Goulart
Eugênio Marcos Andrade
EM
Figueiredo Filho
Paulo Pimenta
PP
Bittencourt
Paulo Fernando Souto
PF
Carvalho
Simone Diniz
SD
Albuquerque
Walton
W
D000293:Adolescent; D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000453:epidemiology* / Q000209:etiology* / Q000473:pathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D007223:Infant; D008103:Liver Cirrhosis / Q000150:complications / Q000151:congenital; D016015:Logistic Models; D008297:Male; D011169:Portal Vein / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013163:Splenomegaly / Q000150:complications; D013921:Thrombocytopenia / Q000150:complications; D013927:Thrombosis / Q000150:complications