Non-invasive Diagnosis of Oesophageal Varices Using Systemic Haemodynamic Measurements by Finometry: Comparison with Other Non-invasive Predictive Scores

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• 作者：Kara Rye ; Gerri Mortimore ; Andrew Austin ; Jan Freeman ; ^{j.freeman115@btinternet.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：MELD ; model of end stage liver disease ; LOV ; large oesophageal varices ; SBP ; systolic blood pressure ; DBP ; diastolic blood pressure ; MAP ; mean arterial pressure ; HR ; heart rate ; SV ; stroke volume ; CO ; cardiac output ; CI ; cardiac index ; PVR ; peripheral resistance ; NIEC ; North Italian Endoscopy Club ; HVPG ; hepatic venous pressure gradient ; PT ; prothrombin time ; AAR ; AST/ALT ratio ; PSDR ; platelet count-to spleen diameter ratio ; IQR ; interquartile range ; ROC ; receiver operating characteristic ; Se ; s
• 刊名：Journal of Clinical and Experimental Hepatology
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：6
• 期：3
• 页码：195-202
• 全文大小：395 K

文摘

Cirrhosis and portal hypertension are characterised by a hyperdynamic circulation, which is independently associated with variceal size. Non-invasive techniques for measurement of systemic haemodynamics are now available.

The aim of the study was to prospectively assess the accuracy of systemic haemodynamics measured non-invasively for the detection of oesophageal varices in cirrhotic patients as compared to other currently available non-invasive methods.

Methods

In a study of 29 cirrhotic patients, systemic haemodynamics were studied non-invasively using the Finometer^® (mean arterial pressure (MAP), cardiac output (CO)/index, heart rate (HR), peripheral vascular resistance) and portal pressure was assessed by hepatic venous pressure gradient. Sensitivity, specificity, predictive values and area under the receiver operating characteristic (ROC) curves were assessed for predicting presence of varices and large oesophageal varices. Results were compared to child's classification, platelet/spleen ratio and ALT/AST ratios as predictors of the presence of large varices.

Results

Using finometry large oesophageal varices were correctly predicted in 83% of patients compared to other non-invasive techniques (range 66–76%).

Conclusions

Non-invasive assessment of systemic haemodynamics using finometry could aid the identification of patients who do not immediately require variceal surveillance reducing the numbers of endoscopies and ensuring services are provided to those most likely to benefit.