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Risk Factors for the Presence of Varices in Cirrhotic Patients Without a History of Variceal Hemorrhage
Atif Zaman, MD, MPH;
Thomas Becker, MD, PhD;
Jodi Lapidus, PhD;
Kent Benner, MD
Arch Intern Med. 2001;161:2564-2570.
Background Current medical management dictates that all cirrhotic patients without
a history of variceal hemorrhage undergo endoscopic screening to detect large
varices. However, referral for endoscopic screening of only patients at highest
risk for varices may be most cost-effective. The aim of this case-control
study was to identify clinical, laboratory, and radiologic findings that predict
the presence of varices in patients with cirrhosis.
Methods Three hundred patients without a history of variceal hemorrhage underwent
upper endoscopy as part of an evaluation before liver transplantation. Cases
defined as the presence of any varices and cases defined as the presence of
large varices were used for examining the risks associated with finding varices
on upper endoscopy. Logistic regression was performed to evaluate associations
between the presence of varices and patient characteristics.
Results Platelet count and Child-Pugh class were independent risk factors for
the presence of any varices and the presence of large varices. For the presence
of any varices, a platelet count of 90 x 103/µL or
less (odds ratio [OR], 2.4; 95% confidence interval [CI], 1.4-4.0) and advanced
Child-Pugh class (OR, 3.0; 95% CI, 1.6-5.6) were independent risk factors.
For large varices, a platelet count of 80 x 103/µL
or less (OR, 2.3; 95% CI, 1.4-3.9) and advanced Child-Pugh class (OR, 2.8;
95% CI, 1.3-5.8) were independent risk factors associated with varices.
Conclusions Low platelet count and advanced Child-Pugh class were associated with
the presence of any varices and with large varices. These factors allow identification
of a subgroup of cirrhotic patients who would benefit most from referral for
endoscopic screening for varices.
From the Division of Gastroenterology and Hepatology, Department of
Medicine (Drs Zaman and Benner), and the Department of Public Health and Preventive
Medicine (Drs Zaman, Becker, and Lapidus), Oregon Health Sciences University,
Portland.
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