title: The predictors of the presence of varices in patients with primary sclerosing cholangitis.
abstract: The predictors for developing varices in patients with primary sclerosing cholangitis (PSC) have not been well studied prospectively. We sought to define the predictors for the presence of varices at baseline and for newly developing varices in patients with PSC. We used prospectively collected data from a multicenter randomized trial of high dose ursodeoxycholic acid for PSC. All 150 patients enrolled were reviewed for predictors of varices and we excluded 26 patients who had esophageal varices at baseline so that predictors of newly developing varices could be determined. Clinical examination, blood tests, and upper endoscopy were done before randomization, at 2 years and after 5 years. Liver biopsy was performed at entry and at 5 years. The median age (interquartile range) of patients was 45.9 years (35.8, 54.9). In a multivariable logistic regression, a higher Mayo risk score (> or =0.87) or a higher aspartate/alanine aminotransferase (AST/ALT) ratio (> or =1.12) were significantly associated with the presence of varices at initial endoscopy (odds ratio = 1.9 and 3.9). By the end of the study, 25 patients had new varices (20.2%). In a Cox model, after adjustment for baseline variables lower platelet count and higher total bilirubin at 2 years were significantly associated with the presence of new varices. The platelet count of 205 (x 10(9)/L) and the total bilirubin level of 1.7 mg/dL were the best cutoff values for the detection of new varices.
  
  
  CONCLUSIONS
  A higher Mayo risk score and higher AST/ALT ratio were significantly associated with the presence of varices at initial endoscopy. Lower platelet count and higher total bilirubin at 2 years were significantly associated with an increased risk of developing new varices in patients with PSC.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, Rochester, MN, USA.
authors.forename: Sombat
authors.initials: S
authors.lastname: Treeprasertsuk
authors.forename: Kris V
authors.initials: KV
authors.lastname: Kowdley
authors.forename: Velimir A C
authors.initials: VA
authors.lastname: Luketic
authors.forename: M Edwyn
authors.initials: ME
authors.lastname: Harrison
authors.forename: Timothy
authors.initials: T
authors.lastname: McCashland
authors.forename: Alex S
authors.initials: AS
authors.lastname: Befeler
authors.forename: Denise
authors.initials: D
authors.lastname: Harnois
authors.forename: Roberta
authors.initials: R
authors.lastname: Jorgensen
authors.forename: Jan
authors.initials: J
authors.lastname: Petz
authors.forename: Jill
authors.initials: J
authors.lastname: Keach
authors.forename: Jeff
authors.initials: J
authors.lastname: Schmoll
authors.forename: Tanya
authors.initials: T
authors.lastname: Hoskin
authors.forename: Prabin
authors.initials: P
authors.lastname: Thapa
authors.forename: Felicity
authors.initials: F
authors.lastname: Enders
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lindor
mesh_terms: D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015209:Cholangitis, Sclerosing / Q000150:complications*; D004932:Esophageal and Gastric Varices / Q000209:etiology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk
chemical_list: D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase