title: Noninvasive methods for prediction of esophageal varices in pediatric patients with portal hypertension.
abstract: OBJECTIVE
  To evaluate clinical and laboratory parameters for prediction of bleeding from esophageal varices (EV) in children with portal hypertension.
  
  
  METHODS
  Retrospective study of 103 children (mean age: 10.1 ± 7.7 years), 95.1% with intrahepatic portal hypertension. All patients had no history of bleeding and underwent esophagogastroduodenoscopy for EV screening. We recorded variceal size (F1, F2 and F3), red-color signs and portal gastropathy, according to the Japanese Research Society for Portal Hypertension classification. Patients were classified into two groups: with and without EV. Seven noninvasive markers were evaluated as potential predictors of EV: (1) platelet count; (2) spleen size z score, expressed as a standard deviation score relative to normal values for age; (3) platelet count to spleen size z score ratio; (4) platelets count to spleen size (cm) ratio; (5) the clinical prediction rule (CPR); (6) the aspartate aminotransferase to platelet ratio index (APRI); and (7) the risk score.
  
  
  RESULTS
  Seventy-one children had EV on first endoscopy. On univariate analysis, spleen size, platelets, CPR, risk score, APRI, and platelet count to spleen size z score ratio showed significant associations. The best noninvasive predictors of EV were platelet count [area under the receiver operating characteristic curve (AUROC) 0.82; 95%CI: 0.73-0.91], platelet: spleen size z score (AUROC 0.78; 95%CI: 0.67-0.88), CPR (AUROC 0.77; 95%CI: 0.64-0.89), and risk score (AUROC 0.77; 95%CI: 0.66-0.88). A logistic regression model was applied with EV as the dependent variable and corrected by albumin, bilirubin and spleen size z score. Children with a CPR < 114 were 20.7-fold more likely to have EV compared to children with CPR > 114. A risk score > -1.2 increased the likelihood of EV (odds ratio 7.47; 95%CI: 2.06-26.99).
  
  
  CONCLUSIONS
  Children with portal hypertension with a CPR below 114 and a risk score greater than -1.2 are more likely to have present EV. Therefore, these two tests can be helpful in selecting children for endoscopy.
authors.affiliation: Pediatric Gastroenterology Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 91350-170, Brazil. marinaadami2008@gmail.com
authors.forename: Marina Rossato
authors.initials: MR
authors.lastname: Adami
authors.forename: Cristina Targa
authors.initials: CT
authors.lastname: Ferreira
authors.forename: Carlos Oscar
authors.initials: CO
authors.lastname: Kieling
authors.forename: Vania
authors.initials: V
authors.lastname: Hirakata
authors.forename: Sandra Maria Gonçalves
authors.initials: SM
authors.lastname: Vieira
mesh_terms: D000293:Adolescent; D019540:Area Under Curve; D002648:Child; D004724:Endoscopy / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D006470:Hemorrhage; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications*; D008297:Male; D015588:Observer Variation; D016017:Odds Ratio; D010976:Platelet Count; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D013272:Stomach Diseases / Q000175:diagnosis
keywords: Clinical predictors; Esophageal varices; Pediatric patients; Portal hypertension