Non-invasive predictors of esophageous varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction.
OBJECTIVE
To identify non-invasive predictors of esophageal varices in children and adolescents with chronic liver disease or extrahepatic portal venous obstruction (EHPVO).


METHODS
53 patients younger than 20 years with chronic liver disease or EHPVO and no history of bleeding or prophylactic treatment of esophageal varices (EV) were assessed. They were divided into 2 groups: group I (35 with chronic liver disease) and group II (18 with EHPVO). Their blood count, international normalized ratio (INR), albumin, bilirubin, abdominal ultrasonography and upper endoscopy results were taken. A splenic index was determined by dividing the patients' spleen dimension by its uppermost limit according to their age. The variables were compared to EV presence or not. Univariate (chi-square test, Fischer's exact test and Wilcoxon exact test) and multivariate (logistic regression) analyses were performed. A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve was calculated.


RESULTS
EV were observed in 48.5% of group I patients and in 83.3% of group II patients. Low platelet count (p = 0.0015), splenomegaly (p = 0.0003) and splenic index (p = 0.0007) were statistically significant predictors of EV among group I patients. The multivariate analysis showed low platelet count (odds = 21.7) as an independent predictor of EV in patients with chronic liver disease.


CONCLUSIONS
Platelet count, splenic index and platelet-splenic index ratio were predictors of EV in children and adolescents with chronic liver disease. There were no EV predictors among group II patients.
Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil. rva@terra.com.br
Roberta V
RV
Alcantara
Roberto M
RM
Yamada
Adriana M A
AM
De Tommaso
Maria Angela
MA
Bellomo-Brandão
Gabriel
G
Hessel
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004932:Esophageal and Gastric Varices / Q000097:blood / Q000209:etiology*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000097:blood / Q000209:etiology*; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications; D008107:Liver Diseases / Q000097:blood / Q000150:complications*; D008297:Male; D010976:Platelet Count; D011237:Predictive Value of Tests; D012372:ROC Curve; D013163:Splenomegaly / Q000175:diagnosis; D013921:Thrombocytopenia / Q000175:diagnosis; D055815:Young Adult