Clinical Trials Study
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World J Gastroenterol. Jun 14, 2014; 20(22): 6989-6994
Published online Jun 14, 2014. doi: 10.3748/wjg.v20.i22.6989
New index to predict esophageal variceal bleeding in cirrhotic patients
Xiao-Dan Xu, Jian-Jun Dai, Jian-Qing Qian, Xun Pin, Wei-Jun Wang
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
Author contributions: Xu XD and Qian JQ conceived and designed the study; Dai JJ collected the clinical data; Pin X contributed tools for data analysis; Xu XD, Dai JJ, Qian JQ, Pin X and Wang WJ performed the study; Xu XD and Pin X analyzed and interpreted the data, and wrote the paper.
Supported by Funding from the Changshu Health Department, No. 201204
Correspondence to: Xiao-Dan Xu, MD, Department of Gastroenterology, Changshu Affiliated Hospital of Suzhou University, College Street, Changshu 215500, Jiangsu Province, China. xxd20@163.com
Telephone: +86-512-52706583 Fax: +86-512-52706583
Received: December 5, 2013
Revised: February 7, 2014
Accepted: March 12, 2014
Published online: June 14, 2014
Abstract

AIM: 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%).

CONCLUSION: 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.

Keywords: Portal hypertension, Ultrasound-Doppler, Esophageal variceal bleeding, Decompensated cirrhosis, Endoscopy

Core tip: Bleeding is a common occurrence in cirrhotic patients with portal hypertension and establishing indicators of risk is critical. Although screening by endoscopy is the recommended approach for patients with decompensated cirrhosis, it is an invasive, uncomfortable and costly procedure. In the present study, a new index that combines ultrasound-Doppler and the Model For End-Stage Liver Disease was evaluated as a suitable alternative. This MUI represents a noninvasive, low-cost and convenient method for assessing the risk of esophageal variceal bleeding in decompensated cirrhotic patients.