title: New index to predict esophageal variceal bleeding in cirrhotic patients.
abstract: OBJECTIVE
  To develop a safe, simple, noninvasive and affordable system to predict esophageal variceal bleeding (EVB) in decompensated cirrhosis patients.
  
  
  METHODS
  Four hundred and eighty-six patients with decompensated cirrhosis (238 males and 248 females), with a mean age of 63.1 ± 11.2 years, were admitted to Changshu Affiliated Hospital of Suzhou University between May 2008 and March 2011. Patients enrolled in this study underwent ultrasound-Doppler (US-Doppler) to assess left gastric vein (LGV) blood flow velocity (LGVV) and blood flow direction (LGVBFD), and were evaluated by the Model For End-Stage Liver Disease (MELD) scoring system. All patients received follow-up evaluations every three months. The resulting data were entered into a database after each time point collection.
  
  
  RESULTS
  Four hundred and sixteen patients completed follow-up evaluations for an average of 31.6 mo (range: 12 to 47 mo). Fifty-one (12.3%) patients experienced EVB. The change in the MELD score over three months (ΔMELD), LGVV and LGVBFD were independently associated with EVB occurrence. MELD-US-Doppler Index (MUI), a new index, was developed and calculated using the following logistic regression equation: MUI = Logit (P) = 1.667 (ΔMELD) + 2.096 (LGVV) - 3.245 (LGVBFD) - 1.697. The area under the receiver operating characteristic curve for prediction of EVB occurrence was significantly higher for the MUI [0.858 (95%CI: 0.774-0.920)] than for ΔMELD [0.734 (95%CI: 0.636-0.817); P < 0.05], LGVV [0.679 (95%CI: 0.578-0.769); P < 0.05] or LGVBFD [0.726 (95%CI: 0.627-0.810); P < 0.05] alone. When the MUI was set at 46, the index had high diagnostic accuracy (85.8%), with high specificity (80%) and sensitivity (87.27%).
  
  
  CONCLUSIONS
  The MUI, a noninvasive and affordable index, can predict EVB occurrence in decompensated cirrhotic patients and serve as an alternative when conventional endoscopic screening is declined.
authors.affiliation: Xiao-Dan Xu, Jian-Jun Dai, Jian-Qing Qian, Xun Pin, Wei-Jun Wang, Department of Gastroenterology, Changshu Affiliated Hospital of Suzhou University, Changshu 215500, Jiangsu Province, China.
authors.forename: Xiao-Dan
authors.initials: XD
authors.lastname: Xu
authors.affiliation: Xiao-Dan Xu, Jian-Jun Dai, Jian-Qing Qian, Xun Pin, Wei-Jun Wang, Department of Gastroenterology, Changshu Affiliated Hospital of Suzhou University, Changshu 215500, Jiangsu Province, China.
authors.forename: Jian-Jun
authors.initials: JJ
authors.lastname: Dai
authors.affiliation: Xiao-Dan Xu, Jian-Jun Dai, Jian-Qing Qian, Xun Pin, Wei-Jun Wang, Department of Gastroenterology, Changshu Affiliated Hospital of Suzhou University, Changshu 215500, Jiangsu Province, China.
authors.forename: Jian-Qing
authors.initials: JQ
authors.lastname: Qian
authors.affiliation: Xiao-Dan Xu, Jian-Jun Dai, Jian-Qing Qian, Xun Pin, Wei-Jun Wang, Department of Gastroenterology, Changshu Affiliated Hospital of Suzhou University, Changshu 215500, Jiangsu Province, China.
authors.forename: Xun
authors.initials: X
authors.lastname: Pin
authors.affiliation: Xiao-Dan Xu, Jian-Jun Dai, Jian-Qing Qian, Xun Pin, Wei-Jun Wang, Department of Gastroenterology, Changshu Affiliated Hospital of Suzhou University, Changshu 215500, Jiangsu Province, China.
authors.forename: Wei-Jun
authors.initials: WJ
authors.lastname: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D001783:Blood Flow Velocity; D016009:Chi-Square Distribution; D002681:China; D004932:Esophageal and Gastric Varices / Q000000981:diagnostic imaging* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006785:Hospitals, University; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012307:Risk Factors; D013152:Splanchnic Circulation; D013270:Stomach / Q000098:blood supply*; D013997:Time Factors; D018615:Ultrasonography, Doppler, Color; D014680:Veins / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Decompensated cirrhosis; Endoscopy; Esophageal variceal bleeding; Portal hypertension; Ultrasound-Doppler