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      Predictores no invasivos de várices esofágicas y otros hallazgos endoscópicos de hipertensión portal en pacientes con hepatopatía crónica Translated title: Non-invasive predictors of esophageal varices and other endoscopic findings of portal hypertension in patients with chronic liver disease

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          Abstract

          Resumen Introducción: La hepatopatía crónica tiene un amplio espectro de manifestaciones endoscópicas relacionadas con la hipertensión portal, siendo la presencia de várices esofágicas la que tiene mayor implicación pronóstica y terapéutica. Diversos estudios han investigado la utilidad de marcadores no invasivos para determinar la presencia de VE y así evitar endoscopias innecesarias; sin embargo, poco se ha estudiado su relación con el resto de las manifestaciones endoscópicas de tubo digestivo alto. Objetivo: Determinar el rendimiento diagnóstico de la cantidad de plaquetas, APRI y FIB4 como predictores del grado de várices esofágicas, várices gástricas, gastropatía portal y duodenopatía portal en pacientes con hepatopatía crónica durante endoscopias de cribado en el Hospital Regional ISSSTE Lic. Adolfo López Mateos. Material y métodos: Se realizó un estudio retrospectivo analítico de pacientes referidos para panendoscopia de cribado al servicio de endoscopia gastrointestinal del HRLALM, con diagnóstico de hepatopatía crónica sin episodios previos de sangrado variceal, en el periodo comprendido de enero 2018 a diciembre 2019. Se registraron el grado de várices esofágicas, várices gástricas, gastropatía portal y duodenopatía portal, y se determinó mediante curvas ROC la sensibilidad, especificidad y área bajo la curva del número de plaquetas, APRI y FIB-4 para cada uno de los hallazgos endoscópicos. Los puntos de corte se calcularon mediante el índice de Youden. Resultados: Se analizaron 264 endoscopias, 150 mujeres, 114 hombres, con mediana de edad de 63 años. El 54% fue Child Pugh A, 33% Child Pugh B y 13% Child Pugh C 13%. La etiología más frecuente fue infección por VHC (21%), seguida de hepatopatía por alcohol (19%) y NASH (13%); 36% se encontraban en protocolo de estudio etiológico. En 215 pacientes se encontraron várices esofágicas (81%), de las cuales 38% fueron pequeñas y 62% grandes. Las várices gástricas se detectaron en el 15% de los casos, 40% GOV1, 58% GOV2, 2% IGV1. La gastropatía portal estuvo presente en el 85%, leve en el 72% y severa en el 28%. El 35% presentó duodenopatía portal. El desempeño diagnóstico fue moderado para el número de plaquetas (punto de corte 139,500, AUROC 0.747, sensibilidad 0.79, especificidad 0.37) y para FIB-4 (punto de corte 2.89, AUROC 0.722, sensibilidad 0.79, especificidad 0.63) para la presencia de várices esofágicas. Para el resto de los hallazgos endoscópicos se encontró un desempeño malo o muy malo. Conclusiones: De los índices analizados, solo el número de plaquetas y e FIB-4 alcanzaron como máximo un desempeño moderado para la determinar la presencia de várices esofágica, ambas con sensibilidad alta, pero baja especificidad. Por lo tanto, no pueden recomendarse como sustituto de la panendoscopia de cribado.

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          Diagnostic Accuracy of APRI, AAR, FIB-4, FI, King, Lok, Forns, and FibroIndex Scores in Predicting the Presence of Esophageal Varices in Liver Cirrhosis

          Abstract Aspartate aminotransferase-to-platelet ratio (APRI), aspartate aminotransferase-to-alanine aminotransferase ratio (AAR), FIB-4, FI, King, Lok, Forns, and FibroIndex scores may be simple and convenient noninvasive diagnostic tests, because they are based on the regular laboratory tests and demographic data. This study aimed to systematically evaluate their diagnostic accuracy for the prediction of varices in liver cirrhosis. All relevant papers were searched via PubMed, EMBASE, CNKI, and Wanfang databases. The area under the summary receiver operating characteristic curve (AUSROC), sensitivity, specificity, positive and negative likelihood ratio (PLR and NLR), and diagnostic odds ratio (DOR) were calculated. Overall, 12, 4, 5, 0, 0, 4, 3, and 1 paper was identified to explore the diagnostic accuracy of APRI, AAR, FIB-4, FI, King, Lok, Forns, and FibroIndex scores, respectively. The AUSROCs of APRI, AAR, FIB-4, Lok, and Forns scores for the prediction of varices were 0.6774, 0.7275, 0.7755, 0.7885, and 0.7517, respectively; and those for the prediction of large varices were 0.7278, 0.7448, 0.7095, 0.7264, and 0.6530, respectively. The diagnostic threshold effects of FIB-4 and Forns scores for the prediction of varices were statistically significant. The sensitivities/specificities/PLRs/NLRs/DORs of APRI, AAR, and Lok scores for the prediction of varices were 0.60/0.67/1.77/0.58/3.13, 0.64/0.63/1.97/0.54/4.18, and 0.74/0.68/2.34/0.40/5.76, respectively. The sensitivities/specificities/PLRs/NLRs/DORs of APRI, AAR, FIB-4, Lok, and Forns scores for the prediction of large varices were 0.65/0.66/2.15/0.47/4.97, 0.68/0.58/2.07/0.54/3.93, 0.62/0.64/2.02/0.56/3.57, 0.78/0.63/2.09/0.37/5.55, and 0.65/0.61/1.62/0.59/2.75, respectively. APRI, AAR, FIB-4, Lok, and Forns scores had low to moderate diagnostic accuracy in predicting the presence of varices in liver cirrhosis.
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            Prediction of oesophageal varices in hepatic cirrhosis by simple serum non-invasive markers: Results of a multicenter, large-scale study.

            Preliminary data suggest that non-invasive methods could be useful to assess presence of oesophageal varices (OV) in cirrhotic patients. We aimed to further investigate simple serum non-invasive markers for diagnosing and grading OV. A retrospective set of 510 cirrhotics and a prospective set of 110 cirrhotics were enrolled consecutively in five centers. Platelets, AST-to-ALT ratio, AST-to-platelet-ratio index, Forns' index, Lok index, Fib-4, and Fibroindex were measured within 2 months from upper endoscopy, taken as a gold standard. Performance was expressed as sensitivity, specificity, positive, and negative predictive values (PPV, NPV), accuracy, and area under the curve (AUC). A combination of Lok index (cutoff=1.5) and Forns' index (cutoff=8.8) had 0.80 AUC (0.76-0.84, 95% CI), and high NPV (>90%) to exclude clinically relevant OV, defined as large OV or small OV with red signs or in Child-Pugh C cirrhosis. By applying this combination, upper endoscopy would have been avoided in 1/3 of our cirrhotics. Large OV could be excluded with 96% NPV by Lok index (cutoff=1.5). A combination of Lok index (cutoff=0.9) and Forns' index (cutoff=8.5) predicted presence of any grade OV with good performance: 0.82 AUC (0.76-0.88, 95% CI), 88% PPV. Serum non-invasive markers may be useful as a first line tool to identify cirrhotic patients in which the risk of clinically relevant OV is trivial, and to reduce the number of upper endoscopies. However, we are still far from the possibility of replacing upper endoscopy by simple serum non-invasive markers in the vast majority of patients. Copyright © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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              Portal hypertensive gastropathy: A systematic review of the pathophysiology, clinical presentation, natural history and therapy.

              To describe the pathophysiology, clinical presentation, natural history, and therapy of portal hypertensive gastropathy (PHG) based on a systematic literature review.
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                Author and article information

                Journal
                endo
                Endoscopia
                Endoscopia
                Asociación Mexicana de Endoscopia Gastrointestinal A.C. (Ciudad de México, Ciudad de México, Mexico )
                0188-9893
                2444-6483
                2020
                : 32
                : suppl 2
                : 208-215
                Affiliations
                [1] Ciudad de México orgnameInstituto de Seguridad y Servicios Sociales de los Trabajadores del Estado orgdiv1Hospital Regional ISSSTE “Licenciado Adolfo López Mateos” orgdiv2Endoscopia Gastrointestinal México
                Article
                S2444-64832020000600208 S2444-6483(20)03200000208
                10.24875/end.m20000235
                3d963941-3612-45d8-9708-51eee4c380ae

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 14 August 2020
                : 31 July 2020
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 15, Pages: 8
                Product

                SciELO Mexico


                APRI,Predictores no invasivos,Hipertensión portal,Várices esofágicas,Várices gástricas,Gastropatía hipertensiva portal,Duodenopatía portal,Plaquetas,FIB-4

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