The prevalence and risk factors associated with esophageal varices in subjects with hepatitis C and advanced fibrosis
| Autor: | Arun J. Sanyal, Robert J. Fontana, Adrian M. Di Bisceglie, James E. Everhart, Michael C. Doherty, Gregory T. Everson, John A. Donovan, Peter F. Malet, Savant Mehta, Muhammad Y. Sheikh, Andrea E. Reid, Marc G. Ghany, David R. Gretch, null the HALT-C Trial Group |
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| Rok vydání: | 2006 |
| Předmět: |
Liver Cirrhosis
Male medicine.medical_specialty Time Factors Cirrhosis Biopsy Hepatitis C virus Population Esophageal and Gastric Varices medicine.disease_cause Antiviral Agents Gastroenterology Endoscopy Gastrointestinal chemistry.chemical_compound Esophageal varices Risk Factors Internal medicine Prevalence medicine Humans Radiology Nuclear Medicine and imaging Prospective Studies Prospective cohort study education education.field_of_study Platelet Count business.industry Ribavirin Hepatitis C Hepatitis C Chronic Middle Aged Prognosis medicine.disease Liver chemistry Disease Progression Female Varices business Follow-Up Studies |
| Zdroj: | Gastrointestinal Endoscopy. 64:855-864 |
| ISSN: | 0016-5107 |
| DOI: | 10.1016/j.gie.2006.03.007 |
| Popis: | The factors predictive of the presence or the absence of esophageal varices in hepatitis C virus (HCV) and advanced fibrosis have not been defined.To define the prevalence of esophageal varices and the factors that are positively and negatively with such varices in hepatitis C and advanced fibrosis.A prospective study of esophageal varices and associated risk factors in subjects with hepatitis C and advanced fibrosis.Prerandomization data from the HALT-C (hepatitis C long-term antiviral treatment against cirrhosis) clinical trial.Subjects with bridging fibrosis or cirrhosis, who were virologic nonresponders to treatment with pegylated interferon alpha 2a and ribavirin, underwent endoscopy.Sixteen percent of subjects with bridging fibrosis (95/598) and 39% of subjects with cirrhosis (164/418) had varices (P.0001); 2% of subjects with bridging fibrosis (13/598) and 11% of those with cirrhosis (48/418) had medium or large varices. Subjects with bridging fibrosis and varices had a significantly lower platelet count and higher bilirubin and international normalized ratio (INR) compared with those without varices, suggesting that the biopsy may have underestimated the severity of fibrosis. A platelet count150,000/mm(3) was associated with a negative predictive value of 99% for esophageal varices. By logistic regression modeling, African American race and female sex were protective, whereas a lower platelet count and higher bilirubin and INR predicted varices (c statistic, 0.758).The risk of having varices increases with decreasing platelet counts, increasing bilirubin, and INR. The probability of having medium or large varices at platelet counts150,000/mm(3) is negligible in this population. |
| Databáze: | OpenAIRE |
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