A simple noninvasive score predicts gastroesophageal varices in patients with chronic viral hepatitis.
BACKGROUND
Guidelines recommend upper endoscopic screening of cirrhotic patients for gastroesophageal varices. Cirrhosis is not always distinguishable from chronic hepatitis.


OBJECTIVE
To identify low-risk patients who can be spared upper endoscopy irrespective of a diagnosis of cirrhosis.


METHODS
We evaluated 13 nonendoscopic variables as predictors of esophagogastric varices in 254 patients with hepatitis B or hepatitis C-related chronic liver disease who underwent upper endoscopy.


RESULTS
Any size varices occurred in 30.3% (77/254), and large varices in 12.2% of patients (31/254). Age >50 years [odds ratio (OR): 11.29; 95% confidence interval (CI): 2.33-54.67], platelet count <150,000/mmc (OR: 4.40; 95% CI: 1.85-10.45), albumin <3.6 g/dL (OR: 2.99; 95% CI: 1.31-6.79), and aspartate aminotransferase/alanine aminotransferase ratio >1 (OR: 2.83; 95% CI: 1.26-6.34) independently predicted varices by logistic regression. Using a score based on age >50 years, platelets <150,000/mmc, and aspartate aminotransferase/alanine aminotransferase ratio >1 (1 point/predictor), only 3.2% of patients with a score <2 had varices, all small.


CONCLUSIONS
Patients with chronic viral hepatitis and a score <2 need not undergo upper endoscopy, as they are unlikely to have large varices. Because about 50% of our patients had this score, 50% of upper endoscopies may be safely avoided.
Gentile
Ivan
I
Department of Public Medicine and Social Security, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy. ivan.gentile@alice.it
Viola
Chiara
C
Graf
Maria
M
Liuzzi
Raffaele
R
Quarto
Maria
M
Cerini
Raimondo
R
Piazza
Marcello
M
Borgia
Guglielmo
G
D000328:Adult; D000367:Age Factors; D000368:Aged; D016145:Endoscopy, Digestive System / Q000379:methods*; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications*; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D055815:Young Adult