title: Clinical and laboratory predictors of esophageal varices in children and adolescents with portal hypertension syndrome.
abstract: 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.
authors.affiliation: Department of Pediatrics, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
authors.forename: Eleonora Druve Tavares
authors.initials: ED
authors.lastname: Fagundes
authors.forename: Alexandre Rodrigues
authors.initials: AR
authors.lastname: Ferreira
authors.forename: Mariza Leitão Valadares
authors.initials: ML
authors.lastname: Roquete
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Penna
authors.forename: Eugênio Marcos Andrade
authors.initials: EM
authors.lastname: Goulart
authors.forename: Paulo Pimenta
authors.initials: PP
authors.lastname: Figueiredo Filho
authors.forename: Paulo Fernando Souto
authors.initials: PF
authors.lastname: Bittencourt
authors.forename: Simone Diniz
authors.initials: SD
authors.lastname: Carvalho
authors.forename: Walton
authors.initials: W
authors.lastname: Albuquerque
mesh_terms: 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