Von Willebrand factor and esophageal varices in children with chronic liver diseases (original) (raw)
Related papers
Open Journal of Gastroenterology, 2015
Background: Bleeding esophageal varices (OVs) due to portal hypertension are one of the major complications with high mortality in liver cirrhosis. So, early detection and management are mandatory. Aim: To evaluate the role of Von Willebrand factor (VWF) in predicting the presence of OVs. Patients and Methods: 62 patients with liver cirrhosis representing different Child-Pugh classes were included. The diagnosis of liver cirrhosis was based on the combination of clinical, laboratory and US examinations. All included patients underwent the following investigations: complete blood count, liver function tests (ALT, AST, serum bilirubin, albumin and total protein, prothrombin time (PT) and concentration (PC), INR and serum alkaline phosphatase), serum creatinine, Von Willebrand factor antigen (VWF-Ag) measurement and abdominal US. Upper endoscopic evaluation was done to detect presence or absence of varices (esophageal or gastric) and/or PHG. Results: 38 males and 24 females with their mean age (46 ± 12 years old) were included. Plasma Von Willebrand factor-Ag level was significantly higher in patients with OVs than those without varices (P value = 0.000). Also, its level was significantly higher in patients with higher grade of OVs, G3 than those with G1 or G2 (P value = 0.000). Patients with large OVs including those with G2 and G3 showed significantly higher values of VWF than those with small OVs (NO and G1) (P value = 0.000). VWF was independent predictor for detecting the presence of OVs with good sensitivity (90), specificity (77.3) and accuracy (85.5) at a cutoff value of 1.74 U/ml. Also it was an independent predictor for detecting the presence of large OVs with good sensitivity (91.2), specificity (85.7) and accuracy (88.7) at a cutoff value of 2.16 U/ml. Conclusion: VWF-Ag could be used as a non invasive laboratory independent predictor for the detection of OVs.
Afro-Egyptian Journal of Infectious and Endemic Diseases, 2019
Background and study aim: Baveno VI consensus recommended the use of noninvasive predictors of EV to avoid unnecessary endoscopies. Von Willbrand factor (VWF) and VITRO score, (VWF/ platelet count), are both correlated to liver cirrhosis and fibrosis. The aim of this study was to evaluate the role of VWF and VITRO score as predictors of esophageal varices and their bleeding. Patients and Methods: Seventy seven patients were included in this study. They were randomly selected from cirrhotic patients admitted to endoscopy unit for the first time. They were allocated into two groups; group I: patients who have esophageal varices, group II: patients with no esophageal varices. Results: VWF Ag and VITRO score were significantly higher in the varices group (group I). VWF Ag level was 169.3±20.2 in group I vs 146.8±35.5 µg/dL in group II p<0.001. VITRO score was 2.2±1.1 in group I vs 1.6±0.7 µg/10 8 platelet p=0.05. We found that at cut off value of 153% VWF can predict the presence of EV with sensitivity 88.1% and specificity of 61.1% and AUC= 0.66 p=0.04. VITRO score can predict the presence of varices with sensitivity of 69.5% and specificity of 50% at a cut off value 1.5 AUC=0.065 P=0.05. Conclusion: VWF and VITRO score rise significantly in patients with esophageal varices. Both markers can be reliable in prediction of the presence of EV's. VWF Ag can be reliable marker in prediction of risky and bleeding varices.
Noninvasive assessment of the presence and size of esophageal varices
Vojnosanitetski Pregled, 2023
Background/Aim. A significant number of patients with liver cirrhosis who underwent screening endoscopy do not have esophageal varices (EVs) or have EVs that do not require prophylactic therapy. Given the invasiveness of the procedure, the need to develop nonendoscopic methods in predicting the presence of EVs is reasonable. The aim of the study was to determine the significance of clinical, biochemical, and ultrasonic parameters in the prediction of EVs. Methods. The study included 59 patients with cirrhosis of the liver, 39 (66.1%) patients with EVs, and 20 (33.9%) patients without EVs. In the group of patients with EVs, 22 (56.4%) patients had small EVs, and 17 (46.3%) had large EVs. Clinical parameters that included Child-Pugh (CP) score, ascites, and splenomegaly were evaluated. In all participants, complete blood count, liver function tests, abdominal ultrasound, and gastroscopy were performed, and a platelet count/spleen diameter (PC/SD) ratio was calculated. Results. Univariate logistic regression analysis showed that independent risk factors for the occurrence of EVs were the following: CP B class [odds ratio (OR) 6.67; p = 0.003] and CP C class (OR 23.33; p = 0.005) relative to class A, ascites (OR 7.78; p = 0.001), spleen size (OR 1.035; p = 0.016), bilirubin (OR 1.065; p = 0.007), albumin (OR 0.794; p = 0.001), prothrombin time (OR 0.912; p < 0.001), international normalized ratio-INR (OR 231.364; p < 0.001), platelet count (OR 0.989; p = 0.023), and PC/SD ratio (OR 0.999; p = 0.034). In a multivariate model, it was shown that a decreased platelet count was a statistically significant risk factor for the presence of EVs (OR 0.983; p = 0.023). Leukopenia and the size of the right liver lobe were found to be statistically significant factors for the occurrence of large EVs. Based on the receiver operating characteristic (ROC) curve for the PC/SD ratio, the cutoff value of the test was obtained at 907 (907.11), with a negative predictive value of 76.4% for large EVs. Conclusion. The cutoff value of PC/SD ratio < 907 has a predictive value for the occurrence of large EVs.
New Non-Invasive Index for Detecting Esophageal Varices in Patients with Liver Cirrhosis
Open Journal of Internal Medicine, 2016
Introduction: Many studies have shown that clinical, biochemical and ultrasonographic parameter are predictive of the presence and grading of esophageal varices. Aim of Study: Validation of a noninvasive test called P2/MS and its comparison with other noninvasive tests for the detection of high risk esophageal varices. Patients and Methods: We prospectively enrolled 125 consecutive patients with liver cirrhosis. Complete blood count [CBC], Platelet count by direct method, Liver functions [serum bilirubin, AST, ALT, prothrombin time and concentration and serum albumin], kidney functions, hepatitis markers for B & C, abdominal ultrasonography and upper gastrointestinal endoscopy were done for each patient. Calculation of P2/MS [Platelet count) 2 /{monocyte fraction (%) × segmented neutrophil fraction (%)], API [age-platelet index], APRI [AST-to-platelet ratio index], SPRI [spleen-toplatelet ratio index], ASPRI [age-spleen-to-platelet ratio index] scores and correlating the different scores with the grade of esophageal varices found on upper endoscopy. Results: During processing of our patient's data, we found certain relation between segmented neutrophils, monocytes, platelet count, total bilirubin and the degree of esophageal varices for the detection of high risk varices and a new equation was formulated and we called it P2/MS-B. In predicting high risk esophageal varices HREV, the area under the curve for this new variable was [0.909, 95% confidence interval 0.858-0.961, p = 0.000] which was significantly higher than all the other variables including P2/MS for the detection of HREV. The sensitivity of the new equation for the detection of HREV is 85.3%, the specificity is 83.1%, the positive predictive value is 87.9%, the negative predicative value is 86.0 % and the overall accuracy of the test is 85.6%. Conclusion: A newly detected noninvasive variable for detecting HREV may reliably screen liver cirrhosis patients for HREV and avoid unnecessary endoscopy in low risk patients.
Egyptian Liver Journal, 2021
Background Ruptured esophageal varices (EVs) are a leading cause of death in Portal hypertension (PHT), it has been a big concern of research to screen EVs through non-invasive approaches. This study aimed to evaluate the role of plasma von Willebrand factor antigen (VWF-Ag) assay for early detection of EVs in patients with portal hypertension. This was a cross-sectional study, done on 47 portal hypertensive children and adolescents who were collected from the Pediatrics Hepatology Clinic, Children Hospital, Ain Shams University. All patients were subjected to comprehensive history taking, thorough clinical examination, routine investigations, abdominal ultrasound, upper GI endoscopy, and measurement of plasma VWF-Ag level. The patients were divided based on their endoscopic findings into two groups; a varices group which included 37 patients, and a non-varices group which included 10 patients. Results VWF-Ag rise significantly in patients with EVs, revealing a direct positive assoc...
Screening of Esophageal Varices by Noninvasive Means in Chronic Liver Disease
Euroasian journal of hepato-gastroenterology
Noninvasive assessment of esophageal varices (EV) decreases the medical and financial burden related to screening and helps in the management of patients with chronic liver diseases (CLDs). In this study, our aim was to assess the utility of the platelet count/spleen diameter index for the noninvasive evaluation of EV. In this cross-sectional observational study, a total of 100 CLD patients underwent screening endoscopy for EV in Medicine and Gastroenterology Department, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh. Platelet count/spleen diameter ratio was assessed in all patients and its diagnostic implication was calculated. Upper gastrointestinal endoscopy revealed that 45 (45.0%) patients had medium EV followed by 27 (27.0%) that had small EV and 19 (19.0%) patients had large EV. Receiver operator characteristic (ROC) curve was constructed using platelet count/spleen index, which gave a cut-off value of >905. The validity of platelet count/spleen index evalu...
By-pass Marker for detecting Esophageal Varices in Patients with Chronic Liver Disease
TAJ: Journal of Teachers Association, 2018
This study was designed to make a relation between gall bladder wall thickening (GBWT) measured by ultrasonography and esophageal varices (EV) measured byupper gastrointestinal endoscopy in chronic liver disease patients. Itwas cross-sectional descriptive study. 50 cases ofChronic Liver Disease were recruited. GBWT was measured by ultrasonography and upper gastrointestinal endoscopy was done for assessment of the presence and grade of EV in all cases. Among 50 cases, 34 (68%) were male and 16(32%) were female. Mean age (±SD) of the study population was 46.7 (±13.28) years of age. Esophageal varices were found in 42(84%) cases and 8(16%) cases had no varix. Among 42 cases of esophageal varices 9 cases had grade-I, 17 cases had grade-II and 16 cases had Grade-III esophageal varices. Gall bladder wall thickness up to 3mm was considered as normal. In this study GBWT value between (1-3) mm8 cases had no EV GBWT value between (3.1-5.9) mm ,10 cases had EV(9 cases had grade 1 and 1 case had grade 11 EV); GBWT value between (6-8.9) mm, 16 cases had grade 11 EV and GBWT value between (9-12) mm 16 cases had grade 111 EV. A significant statistical correlation was found between the level of GBWT and EV (P<0.001) and also between mean GBWT and EV (P<0.001). This study shows that the presence of EV is directly related to the level of GBWT and there is also association with the grade of EV and level of GBWT. This finding will permit the use of GBWT as a preliminary indirect parameter that will predict the presence EV. It can help clinicians in determining the urgency of care, especially where endoscopy facilities are not available.
Significance of Non-Invasive Markers as Predictor of Esophageal Varices in Liver Cirrhosis
Journal of Nepal Medical Association, 2017
Introduction: Upper gastro-intestinal endoscopy remains the gold standard for screening for esophageal varices but it has its own limitations. It is an invasive, expensive and uncomfortable procedure and needs clinical expertise. Accordingly, this study was conducted to establish the role of non-invasive markers for prediction of esophageal varices in liver cirrhosis. Methods: A hospital based descriptive cross-sectional study was carried out in Liver unit of National Academy of Medical Sciences, Bir Hospital, from October 2016 to September 2017. Complete blood count, liver function test, liver ultrasound and upper gastro-intestinal endoscopy were done for all patients to detect esophageal varices and to correlate with different non-invasive markers. Results: Total 191 patients of liver cirrhosis were studied after exclusion. Platelet count of 92082.00±43435.83/mm3 and spleen size of 144.21±10.71 mm was found to be good predictors of presence of EV (P≤0.001). Significant association...
Non-invasive assessment of esophageal varices
2019
The assessment of non-invasive parameters for the prediction of large esophageal varices among patients with liver cirrhosisis is of utmost importance. In this study, non-invasive parameters for prediction of large esophageal varices were retrospectively evaluated. The presence of esophageal varices grade III and IV was classified as large esophageal varices positive while no varices or grade I and II were classified as large esophageal varices negative. There were 473 (90.09%) patients with ascites [mild 38 (8.03%), moderate 257 (54.33%) and severe 178 (37.63%)]. Frequency of esophageal varices was found to be higher (n=415, 79.04%). Whereas, large esophageal varices were found in 251 (47.81%) patients. The sensitivity, specificity, positive predicted value, negative predicted value and test accuracy of thrombocytopenia in predicting large esophageal varices were found to be 88.05%, 59.85%, 66.77%, 84.54% and 73.33% respectively. A significant association for large esophageal varic...
Medicina
Background and Objectives: Upper endoscopy is considered the gold standard for screening and diagnosis of esophageal varices (EV). Non-invasive methods for predicting EV have become a research hotspot in recent years. The aim of this study was to assess the role of non-invasive scores in predicting the presence of EV in patients with liver cirrhosis, and to determine the value of these scores in predicting the outcome of patients with cirrhosis presenting with acute variceal bleeding. Materials and Methods: A total of 386 patients with liver cirrhosis were included. The model for end-stage liver disease (MELD), aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AST/ALT), AST to platelet ratio index (APRI), fibrosis-4-index (FIB-4), fibrosis index (FI), King’s Score, albumin-bilirubin (ALBI) score, and platelet-albumin-bilirubin (PALBI) score were calculated. The discriminatory capacities of the examined scores in predicting the presence of esophageal varices w...