The predictors of the presence of varices in patients with primary sclerosing cholangitis
Open accessAbstract
UNLABELLED: The predictors for developing varices in patients with primary sclerosing cholangitis (PSC) have not been well studied prospectively. We sought to define the predictors for the presence of varices at baseline and for newly developing varices in patients with PSC. We used prospectively collected data from a multicenter randomized trial of high dose ursodeoxycholic acid for PSC. All 150 patients enrolled were reviewed for predictors of varices and we excluded 26 patients who had esophageal varices at baseline so that predictors of newly developing varices could be determined. Clinical examination, blood tests, and upper endoscopy were done before randomization, at 2 years and after 5 years. Liver biopsy was performed at entry and at 5 years. The median age (interquartile range) of patients was 45.9 years (35.8, 54.9). In a multivariable logistic regression, a higher Mayo risk score (> or =0.87) or a higher aspartate/alanine aminotransferase (AST/ALT) ratio (> or =1.12) were significantly associated with the presence of varices at initial endoscopy (odds ratio = 1.9 and 3.9). By the end of the study, 25 patients had new varices (20.2%). In a Cox model, after adjustment for baseline variables lower platelet count and higher total bilirubin at 2 years were significantly associated with the presence of new varices. The platelet count of 205 (x 10(9)/L) and the total bilirubin level of 1.7 mg/dL were the best cutoff values for the detection of new varices. CONCLUSION: A higher Mayo risk score and higher AST/ALT ratio were significantly associated with the presence of varices at initial endoscopy. Lower platelet count and higher total bilirubin at 2 years were significantly associated with an increased risk of developing new varices in patients with PSC.
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In a multivariable logistic regression, a higher Mayo risk score (>0.87) or a higher aspartate/alanine aminotransferase ratio (>1.12) were associated with the presence of varices at initial endoscopy.
“In a multivariable logistic regression, a higher Mayo risk score (>0.87) or a higher aspartate/alanine aminotransferase ratio (>1.12) were associated with the presence of varices at initial endoscopy.”
From EASL Clinical Practice Guidelines on sclerosing cholangitis (2022) · cites this paper as [249]
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- Authors
- Treeprasertsuk, S., Kowdley, K. V., Luketic, V. A. C., Harrison, M. E., McCashland, T., Befeler, A. S., Harnois, D., Jorgensen, R., Petz, J., Keach, J., Schmoll, J., Hoskin, T., Thapa, P., Enders, F., & Lindor, K. D.
- Affiliations
- Mayo Clinic (US)
- Virginia Mason Medical Center (US)
- Virginia Commonwealth University (US)
- Mayo Clinic in Arizona (US)
- University of Nebraska–Lincoln (US)
- Saint Louis University (US)
- Corresponding author
- Lindor, Keith D.
- ORCID
- Venue
- Hepatology
- Published
- 2010-04
- Volume
- 51
- Issue
- 4
- Pages
- 1302-1310
- ISSN
- 0270-9139 (ISSN-L)
- PMC
- PMC2898188
- OpenAlex
- W2057687027
- Cited by
- 26
- References
- 27
- Citations by year
- 2026: 1 · 2023: 1 · 2022: 1 · 2020: 1 · 2019: 2 · 2018: 5 · 2017: 4 · 2015: 2 · 2014: 1 · 2013: 3 · 2012: 3
- FWCI
- 0.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hepatology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Virginia Commonwealth University
- National Institute of Allergy and Infectious Diseases (R01AI056924)
- National Institute of Diabetes and Digestive and Kidney Diseases (R03DK053935, DK 56924, K24DK002957, R01DK056924)
- National Center for Research Resources (M01RR000065)
- Topics
- Health Sciences › Medicine › Hepatology › Liver Diseases and Immunity
- Health Sciences › Medicine › Hepatology › Liver Disease and Transplantation
- Health Sciences › Medicine › Surgery › Pediatric Hepatobiliary Diseases and Treatments
- Keywords
- primary sclerosing cholangitis, esophageal varices, risk factors, Mayo risk score, AST/ALT ratio, platelet count, total bilirubin, ursodeoxycholic acid, liver cirrhosis
- MeSH terms
- Adult, Alanine Transaminase, Aspartate Aminotransferases, Esophageal and Gastric Varices, Female, Humans, Male, Middle Aged, Prospective Studies, Risk, Cholangitis, Sclerosing, Logistic Models, Proportional Hazards Models
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