Prediction of esophageal varices in biliary atresia: Derivation of the "varices prediction rule", a novel noninvasive predictor

Journal of Pediatric Surgery
Alexander IstedM Davenport

Abstract

Liver fibrosis and cirrhosis are nearly inevitable following Kasai portoenterostomy (KPE) for biliary atresia (BA), though the formation of varices is not. We sought to assess the value of noninvasive indices of portal hypertension (PHT), in predicting significant esophageal varices, and to develop a novel prediction model through regression modeling. This is a retrospective, observational study with analysis of routine biochemical and ultrasound data. Five indices were examined: AST-to-platelet ratio index (APRi); hepatic artery resistance index (HARI); spleen size z score (SSAZ); platelet count-to-SSAZ ratio (P/SSAZ); and clinical prediction rule (CPR) [(0.75 × platelets)/(SSAZ+5)]+(2.5 × albumin), each at specific time points following KPE (6 months, 1 year and 2 years). Significant varices were defined as grade ≥ 2 at endoscopy (screening or following a gastrointestinal bleed). AUROC was calculated for all indices. Univariate analysis was used to assess variables' suitability for inclusion in a subsequent multivariate logistic regression model to generate a predictive index. Data are quoted as median (range). P values ≤ 0.05 were regarded as significant. 195 infants (median age at KPE of 55 days [11-216]) were analyzed. 42 ...Continue Reading

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Citations

Oct 18, 2016·Journal of Pediatric Gastroenterology and Nutrition·Peter WittersTassos Grammatikopoulos
Dec 30, 2017·Journal of Pediatric Gastroenterology and Nutrition·Harry SuttonTassos Grammatikopoulos
Jan 14, 2018·Hepatology Research : the Official Journal of the Japan Society of Hepatology·Roberta FrassettoMaria Grazia Clemente
Feb 26, 2020·Current Opinion in Gastroenterology·Jeremy DanaDominique Debray
Aug 18, 2017·Archives of Disease in Childhood·Tassos GrammatikopoulosAnil Dhawan
Jul 28, 2019·Journal of Pediatric Gastroenterology and Nutrition·Palittiya SintusekYong Poovorawan
Dec 12, 2020·Hepatology Communications·Veena VenkatUNKNOWN Childhood Liver Disease Research Network
Jan 6, 2021·Journal of Pediatric Gastroenterology and Nutrition·José Ricardo Borém LopesLucas Garcia de Figueiredo Colin

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